Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kellie Kodama

Individual provider Physician Assistant · NPI 1164146494

Kellie Kodama is a Physician Assistant in Fullerton, California. Qualified in 2023, 3 years ago. Practices with Sunny Hills Medical Center Inc, a 4-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Arizona and California.

Years since qualifying
3
Licensed in
AZ, CA
In the registry since
2022
Specialties on file
2
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Practice location Address checks out

2575 Yorba Linda Blvd
Fullerton, CA 92831-1615
Phone: (714) 449-7400
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 7510 W Thomas Rd Ste 104, Phoenix, AZ 85033-5407 — (480) 677-8282

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X (CA)
Physician Assistant Taxonomy 363A00000X · Licence 11685 (AZ)

Record details

NPI number1164146494
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedSeptember 29, 2022
Last updated in NPPESJune 1, 2026
Certification dateJune 1, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Sunny Hills Medical Center Inc — 4 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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