Provider Demographics
NPI:1508106600
Name:GORDON, KALI L (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:KALI
Middle Name:L
Last Name:GORDON
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 E NORTH ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:ALTURAS
Mailing Address - State:CA
Mailing Address - Zip Code:96101-4072
Mailing Address - Country:US
Mailing Address - Phone:215-260-8867
Mailing Address - Fax:
Practice Address - Street 1:PIT RIVER HEALTH SERVICE
Practice Address - Street 2:150 BUREAU OF INDIAN AFFAIRS #76A
Practice Address - City:ALTURAS
Practice Address - State:CA
Practice Address - Zip Code:96101
Practice Address - Country:US
Practice Address - Phone:530-233-3223
Practice Address - Fax:530-233-3296
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-26
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA72733207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty