Provider Demographics
NPI:1851616056
Name:HAAS, KELLY BETH (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:BETH
Last Name:HAAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:BETH
Other - Last Name:TRANGSRUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2516 STOCKTON BLVD STE 367
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2208
Mailing Address - Country:US
Mailing Address - Phone:916-734-3720
Mailing Address - Fax:916-734-4098
Practice Address - Street 1:2516 STOCKTON BLVD STE 367
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2208
Practice Address - Country:US
Practice Address - Phone:916-734-3720
Practice Address - Fax:916-734-4098
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1200422080P0206X, 2080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology