Provider Demographics
NPI:1386835106
Name:KELLEY, KATHERINE CHEMODUROW (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:CHEMODUROW
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:CHEMODUROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:490 POST ST. SUITE 1043
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102
Mailing Address - Country:US
Mailing Address - Phone:415-296-5290
Mailing Address - Fax:
Practice Address - Street 1:490 POST ST
Practice Address - Street 2:SUITE 1043
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-1401
Practice Address - Country:US
Practice Address - Phone:415-296-5290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ439262084P0800X
SC301012084P0800X
CAA1160712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry