Individual
KELLY JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
747 52ND ST, OAKLAND, CA 94609-1809
(510) 428-3331
Mailing address
3261 FRANKLIN AVE E APT 7, SEATTLE, WA 98102-3858
(949) 981-0626
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
MD60945855
WA
2080P0203X
Pediatric Critical Care Medicine Physician
333542
LA
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
MD60945855
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/05/2016
Last updated
12/20/2022
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