Provider Demographics
NPI:1992182257
Name:TAFET, KELLIE A (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:A
Last Name:TAFET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:
Other - Last Name:TOPORCZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:835 S WOOSTER ST APT 107
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1747
Mailing Address - Country:US
Mailing Address - Phone:716-380-7216
Mailing Address - Fax:
Practice Address - Street 1:835 S WOOSTER ST APT 107
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1747
Practice Address - Country:US
Practice Address - Phone:716-380-7216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA148095390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program