Kelly Phommahaxay, MD
Kelly Phommahaxay, MD is registered under Family Practice in LA Mesa, California. Qualified in 2014, 12 years ago. Practices with Southern California Permanente Medical Group, an 11,242-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in Minnesota.
- Years since qualifying
- 12
- Licensed in
- MN
- In the registry since
- 2014
- Specialties on file
- 2
What do these letters mean?
- MD — Doctor of Medicine
- A physician who completed allopathic medical school.
Practice location Address checks out
LA Mesa, CANo coordinates on file. Search this address in Google Maps
Additional practice locations (2)
- 330 N 8th Ave E, Duluth, MN 55805-2024 — (218) 723-1112
- 1039 Montgomery St, Custer, SD 57730-1304 — (605) 673-2229
Specialties & licences
| Family Medicine Physician (primary) | Taxonomy 207Q00000X · Licence 59533 (MN) |
|---|---|
| Student in an Organized Health Care Education/Training Program | Taxonomy 390200000X |
Record details
| NPI number | 1770997173 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Female |
| Credentials | MD |
| Sole proprietor | No |
| NPI enumerated | June 13, 2014 |
| Last updated in NPPES | January 18, 2024 |
| Certification date | January 18, 2024 |
Medicare enrollment
| Medicare specialty | FAMILY PRACTICE |
|---|---|
| Medical school | OTHER |
| Graduated | 2014 (12 years in practice) |
| Group practice | Southern California Permanente Medical Group — 11242 clinicians |
| Accepts Medicare assignment | Yes — accepts the Medicare-approved amount |
| Practice locations | 2 on file with Medicare |
Other providers in LA Mesa
-
Satenik Melkonyan
Student / training record LA Mesa, CA
-
Mariam Mostamand, MD
Student / training record LA Mesa, CA
-
Kimberly Nguyen, MD
Student / training record LA Mesa, CA
-
Roumta Ashor Odisho, MD
Student / training record LA Mesa, CA
-
Justin Rice, MFTTRAINEE
Student / training record LA Mesa, CA
-
Roseanne April Rodriguez, LCSW
Student / training record LA Mesa, CA
-
Dr. Michael Simon, DMD
Student / training record LA Mesa, CA
-
Caprice Nicoline Emmer Thompson, DO
Student / training record LA Mesa, CA