Provider Demographics
NPI:1003045683
Name:TILESTON, KALI ROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:KALI
Middle Name:ROSE
Last Name:TILESTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KALI
Other - Middle Name:ROSE
Other - Last Name:LUKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:319 HIGHLAND TER
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:94062-3520
Mailing Address - Country:US
Mailing Address - Phone:510-520-7281
Mailing Address - Fax:
Practice Address - Street 1:319 HIGHLAND TER
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:CA
Practice Address - Zip Code:94062-3520
Practice Address - Country:US
Practice Address - Phone:510-520-7281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-05
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA113697207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery