KELLY JORDAN (NPI# 1083060396) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083060396 |
| Entity Type | Individual |
| Full Name | KELLY JORDAN |
| Credential | M.D. |
| Practice Address |
747 52nd St Oakland CA 94609-1809 |
| Practice Telephone | 5104283331 |
| Mailing Telephone | 5104283331 |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2016-05-05 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295178572 | Kelly E Jordan | Recreation Therapist | 21800 Celestial Cir, Pinckney, MI 48169-8765 | 2013-04-17 |
| 1356826325 | Kelly Jordan | Psychologist | 516 Mission House Ln, New Brighton, MN 55112-2571 | 2018-09-26 |
| 1124576426 | Kelly Jordan | Counselor | 51 Marina Blvd, Pittsburg, CA 94565-2068 | 2016-09-14 |
| 1023377819 | Kelly Jean Jordan | Dental Hygienist | 2300 Lancaster Dr Ne, Salem, OR 97305-1223 | 2012-05-14 |
| 1669647020 | Kelly Jordan | Counselor | 420 Kellogg Ave, Ames, IA 50010-6226 | 2008-04-28 |
| 1467624809 | Kelly M Jordan | Physician Assistant | 4949 Harlem Rd, Amherst, NY 14226-2500 | 2008-03-26 |
| 1952501819 | Kelly E Jordan | Physical Therapist | 1610 Center St, Mobile, AL 36604-1512 | 2007-07-19 |
| Street Address |
747 52ND ST |
| City | OAKLAND |
| State | CA |
| Zip Code | 94609-1809 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942200928 | James Philip Riddel Jr. | Nurse Practitioner | 747 52nd St, Oakland, CA 94609-1809 | 2005-07-29 |
| 1235739905 | Maria Elena Alicia Valdivia Fortuna | Social Worker | 747 52nd St, Oakland, CA 94609-1809 | 2020-10-30 |
| 1295342707 | Jenny Chen | Dietitian, Registered | 747 52nd St, Oakland, CA 94609-1809 | 2020-09-29 |
| 1104433028 | Phuong T Nguyen-tran | Pharmacist | 747 52nd St, Oakland, CA 94609-1809 | 2020-09-24 |
| 1114538899 | Ji Yun Lee | Student in an Organized Health Care Education/Training Program | 747 52nd St, Oakland, CA 94609-1809 | 2020-08-14 |
| 1780295857 | Luis Alonso Perez Jr. | Social Worker | 747 52nd St, Oakland, CA 94609-1809 | 2020-08-12 |
| 1255941803 | Aleesia Renta-ramirez | Student in an Organized Health Care Education/Training Program | 747 52nd St, Oakland, CA 94609-1809 | 2020-08-07 |
| 1831709773 | Carroll Taylor Brown IIi | Registered Nurse | 747 52nd St, Oakland, CA 94609-1809 | 2020-08-05 |
| 1053921064 | Jessica Stankiewicz Lightcap | Registered Nurse | 747 52nd St, Oakland, CA 94609-1809 | 2020-08-04 |
| 1184242307 | Cecilia Fairley | Genetic Counselor, MS | 747 52nd St, Oakland, CA 94609-1809 | 2020-07-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104457159 | Gerard John-charles Coughlin | Student in an Organized Health Care Education/Training Program | Samuel Merritt University, 3100 Telegraph Avenue, Oakland, CA 94609 | 2020-01-29 |
| 1417502022 | Michael Knittel | Registered Nurse | 370 Hawthorne Ave, Oakland, CA 94609 | 2019-08-09 |
| 1962057562 | Nicole Kjolby | Registered Nurse | Samuel Merritt College, 370 Hawthorne Ave, Oakland, CA 94609 | 2019-08-09 |
| 1396208286 | Graham Vallis | Student in an Organized Health Care Education/Training Program | Ucsf Benioff Children's Hospital Oakland, 747 52nd Street, Oakland, CA 94609 | 2019-04-09 |
| 1386129526 | Gary Mitchell Snider | Counselor | 390 40th Street, Oakland, CA 94609 | 2018-10-02 |
| 1720568389 | Lice Control Inc. | Technician | 6557 Shattuck Ave, Oakland, CA 94609 | 2018-08-14 |
| 1528559150 | Jenna Marie Kincaid | Behavior Technician | 400 29th St., 204, Oakland, CA 94609 | 2018-05-18 |
| 1336656669 | Nicholas Dicarlo | Social Worker | 465 34th St Ste 6, Oakland, CA 94609 | 2018-01-09 |
| 1174045744 | Theodora J Marzouk | Home Health Aide | 3317 Elm Street, Suite 202, Oakland, CA 94609 | 2017-07-14 |
| 1740728922 | Elena Gardella | Marriage & Family Therapist | 411 30th Street, Suite 412, Oakland, CA 94609 | 2017-02-07 |
| Find all providers in zip 94609 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750988762 | Mohini Gadre | Student in an Organized Health Care Education/Training Program | Casa Del Sol, 1501 Fruitvale Ave, Oakland, CA 94601 | 2020-10-02 |
| 1063028454 | Abduljabbar Alhammoud | Student in an Organized Health Care Education/Training Program | Kaiser Permanente Oakland Medical Center 275 W. Macarth, Oakland, CA 94611 | 2020-09-21 |
| 1316553290 | Yohannes Fesseha Gebrehiwet | Student in an Organized Health Care Education/Training Program | 2221 9th Ave, Oakland, CA 94606-2613 | 2020-09-16 |
| 1700490729 | Briauna J Taylor | Student in an Organized Health Care Education/Training Program | 1638 47th Ave, Oakland, CA 94601-5273 | 2020-09-08 |
| 1578174116 | Jenae Monasterial | Student in an Organized Health Care Education/Training Program | 1722 Clemens Rd, Oakland, CA 94602-1802 | 2020-08-16 |
| 1205447299 | Brendan Mulligan | Student in an Organized Health Care Education/Training Program | 530 24th St Apt 202, Oakland, CA 94612-1723 | 2020-08-12 |
| 1962029595 | Yuan Yan | Student in an Organized Health Care Education/Training Program | 310 8th Street, Suit 210 Asian Health Services: Special, Oakland, CA 94607 | 2020-06-30 |
| 1043836778 | Ali Khavari | Student in an Organized Health Care Education/Training Program | 450 30th St Ste 2860, Oakland, CA 94609-3302 | 2020-06-18 |
| 1952925208 | Melodee Edith Au | Student in an Organized Health Care Education/Training Program | 2445 Telegraph Ave Apt 305, Oakland, CA 94612-2426 | 2020-06-02 |
| 1871116913 | Stew Ellington | Student in an Organized Health Care Education/Training Program | 420 Avon St, Oakland, CA 94618-1024 | 2020-05-23 |
| Find all providers in OAKLAND | ||||
Please comment or provide details below to improve the information on KELLY JORDAN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.