Provider Demographics
NPI:1477565356
Name:KISSEL, AARON CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:CHRISTOPHER
Last Name:KISSEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:AARON
Other - Middle Name:CHRISTOPHER
Other - Last Name:KISSEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2740 HERNDON AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6813
Mailing Address - Country:US
Mailing Address - Phone:559-299-2608
Mailing Address - Fax:559-299-1341
Practice Address - Street 1:32938 ROAD 222
Practice Address - Street 2:SUITE 2
Practice Address - City:NORTH FORK
Practice Address - State:CA
Practice Address - Zip Code:93643-9562
Practice Address - Country:US
Practice Address - Phone:559-877-4676
Practice Address - Fax:559-877-7788
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA065462207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H11617Medicare UPIN