Provider Demographics
NPI:1669653432
Name:CHUKUNTAROD, KELLY (RN, PHN)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:CHUKUNTAROD
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-4005
Mailing Address - Country:US
Mailing Address - Phone:415-292-1304
Mailing Address - Fax:415-440-2364
Practice Address - Street 1:1301 PIERCE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-4005
Practice Address - Country:US
Practice Address - Phone:415-292-1304
Practice Address - Fax:415-440-2364
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA630841163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management