Kelly Portnoff, M.D., Inc.

Primary specialty

Rheumatology PhysicianTaxonomy code 207RR0500X

License

A067472 Issued in CA

Legal business name

KELLY PORTNOFF, M.D., INC.

Practice address

25411 Cabot Rd
Suite 109
Laguna Hills, CA 92653-5520

Phone

(949) 364-5119

Fax

(949) 364-1265

NPI assigned

Dec 17, 2008

Organization subpart

No

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

Authorized official

Name

Mrs. Karen E Offord

Title

Office Manager

Phone

(949) 364-5119

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1229472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229472000000",
    "number": "1144466384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25411 CABOT RD",
            "address_2": "SUITE 109",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926535520",
            "telephone_number": "949-364-5119",
            "fax_number": "949-364-1265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25411 CABOT RD",
            "address_2": "SUITE 109",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926535520",
            "telephone_number": "949-364-5119",
            "fax_number": "949-364-1265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY PORTNOFF, M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-17",
        "last_updated": "2008-12-17",
        "status": "A",
        "authorized_official_last_name": "OFFORD",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "949-364-5119",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": "CA",
            "license": "A067472",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PPIN",
            "identifier": "WA67472G",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel Katz, M.D.
• Denese Dawn Kaufeldt Montano, P.T.
• Suzanne Helen Kearney
• Keeban Nam, M.D., Inc.
• Keemia Medical Corp
• Ata Kelly, L.AC., MD
• Kylene Kelly, ED.D.C.P.
• Patrick Kevin Kelly
• Shawna Kemp, OTR
• Kristen Kempiak, OTA

• Rheumatology Physician in Laguna Hills, CA
• Providers in Laguna Hills, CA by specialty
• Rheumatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.