Basic Information
| Provider Information | |||||||||
| NPI: | 1477565356 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KISSEL | ||||||||
| FirstName: | AARON | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KISSEL | ||||||||
| OtherFirstName: | AARON | ||||||||
| OtherMiddleName: | CHRISTOPHER | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2740 HERNDON AVE | ||||||||
| Address2: | |||||||||
| City: | CLOVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936116813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592992608 | ||||||||
| FaxNumber: | 5592991341 | ||||||||
| Practice Location | |||||||||
| Address1: | 32938 ROAD 222 | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | NORTH FORK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936439562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5598774676 | ||||||||
| FaxNumber: | 5598777788 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2006 | ||||||||
| LastUpdateDate: | 09/19/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A065462 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.