Individual
IAN ISIAH KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4892 SAN PABLO DAM RD, EL SOBRANTE, CA 94803-3222
(510) 222-3946
Mailing address
1062 16TH ST, OAKLAND, CA 94607-2832
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
09/23/2014
Last updated
03/01/2024
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