Provider Demographics
NPI:1821631458
Name:NISHIHARA, KELCEY
Entity Type:Individual
Prefix:
First Name:KELCEY
Middle Name:
Last Name:NISHIHARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 SUTTER ST STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-5465
Mailing Address - Country:US
Mailing Address - Phone:415-379-9600
Mailing Address - Fax:415-379-9823
Practice Address - Street 1:1375 SUTTER ST STE 105
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5465
Practice Address - Country:US
Practice Address - Phone:415-379-9600
Practice Address - Fax:415-379-9823
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-27
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant