Provider Demographics
NPI:1841599933
Name:SIDHPURA, KELLY VASANT (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:VASANT
Last Name:SIDHPURA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:VASANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:MATTEL CHILDREN'S HOSPITAL UCLA
Mailing Address - Street 2:10833 LECONTE AVENUE, 12-494 MDCC
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-0001
Mailing Address - Country:US
Mailing Address - Phone:310-825-6752
Mailing Address - Fax:
Practice Address - Street 1:9985 SIERRA AVE FL MOB22
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335
Practice Address - Country:US
Practice Address - Phone:909-427-5311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA125057208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics