Provider Demographics
NPI:1578182606
Name:NA, KELLEN YEONSU (MD)
Entity Type:Individual
Prefix:
First Name:KELLEN
Middle Name:YEONSU
Last Name:NA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9394 BIG HORN BLVD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7977
Practice Address - Country:US
Practice Address - Phone:916-691-8500
Practice Address - Fax:916-691-8589
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA185495207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine