Individual
KELLY KHAMKONGSAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9064 VAN NUYS BLVD, PANORAMA CITY, CA 91402-1813
(818) 352-8333
Mailing address
9064 VAN NUYS BLVD, PANORAMA CITY, CA 91402-1813
(818) 352-8333
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
95015584
CA
Other
Enumeration date
12/31/2020
Last updated
12/31/2020
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