Individual
KRISTEN WIKHOLM KIELEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1100 MONTEREY ST STE 200, SAN LUIS OBISPO, CA 93401-3102
(805) 542-9700
(805) 542-0584
Mailing address
590 LA TAPADERA LN, NIPOMO, CA 93444-9479
(805) 260-6785
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
25161
MN
2085R0202X
Diagnostic Radiology Physician
25161
MN
2085R0202X
Diagnostic Radiology Physician
Primary
A130814
CA
2085U0001X
Diagnostic Ultrasound Physician
25161
MN
Other
Enumeration date
06/05/2009
Last updated
11/11/2014
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