Individual provider Active NPI

Kelley Liao, MD

  • Family Medicine Physician
  • Petaluma, CA
National Provider Identifier
1053053694
Registry record updated Aug 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A200873 Issued in CA
Practice address
335 S McDowell Blvd
Petaluma, CA 94954-3507
Phone
(628) 336-5260
Fax
(628) 240-2138
NPI assigned
Apr 13, 2022
Last updated
Aug 8, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A200873 CA Primary

Addresses

Primary practice location

335 S McDowell Blvd
Petaluma, CA 94954-3507

Mailing address

335 S McDowell Blvd
Petaluma, CA 94954-3507
Phone (628) 336-5260

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250715003468 CA Practitioner - Family Practice 5698157675 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Texas a & M University System, HSC, College of Medicine, 2022
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Regents Univ of California UCSFGroup PAC ID 6305160300, 276 clinicians

Practice addresses (Care Compare)

505 Parnassus Ave
San Francisco, CA 94143-2204
Phone (415) 476-1000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A200873CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents Univ of California UCSF CurrentSince Jun 18, 2025 Accepting new patients

Locations

505 Parnassus Ave
San Francisco, CA 94143
Phone (415) 476-9058

Interoperability endpoints

  • Direct secure messaging: kliao431776@direct-ucsfmedicalcenter.org

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754611200000",
    "number": "1053053694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "335 S MCDOWELL BLVD",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949543507",
            "telephone_number": "628-336-5260",
            "fax_number": "628-240-2138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "335 S MCDOWELL BLVD",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949543507",
            "telephone_number": "628-336-5260",
            "fax_number": "628-240-2138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIAO",
        "first_name": "KELLEY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-13",
        "last_updated": "2025-08-08",
        "certification_date": "2025-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A200873",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Petaluma, CA

Sources for this page

Verify at the official NPI Registry.