Individual provider Active NPI

Kelly McKoin, PA-C

  • Physician Assistant
  • San Rafael, CA
National Provider Identifier
1316392277
Registry record updated Sep 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
53228 Issued in CA
Practice address
800 A St
San Rafael, CA 94901-3011
Phone
(415) 457-8182
Fax
(415) 457-7471
NPI assigned
Apr 28, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 53228 CA Primary

Addresses

Primary practice location

800 A St
San Rafael, CA 94901-3011

Mailing address

PO Box 3517
San Rafael, CA 94912-3517
Phone (415) 457-8182

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170823003232 CA Practitioner - Physician Assistant 6800168923 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
53228CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
AIDS Healthcare Foundation CurrentSince Aug 30, 2023 Accepting new patients
AIDS Healthcare Foundation CurrentSince Aug 30, 2023 Accepting new patients

Locations

6255 W Sunset Blvd
Fl 21
Los Angeles, CA 90028
Phone (323) 860-5200

400 30th St
Ste 300
Oakland, CA 94609
Phone (510) 628-0949

238 E 18th St
Oakland, CA 94606
Phone (510) 251-8678

3580 5th Ave
San Diego, CA 92103
Phone (619) 516-8931

518A Castro St
San Francisco, CA 94114
Phone (415) 255-2720

Interoperability endpoints

  • Direct secure messaging: kelly.mckoin.1@26356.direct.athenahealth.com

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1461801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788912000000",
    "number": "1316392277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3517",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949123517",
            "telephone_number": "415-457-8182",
            "fax_number": "415-457-7471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 A ST",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949013011",
            "telephone_number": "415-457-8182",
            "fax_number": "415-457-7471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKOIN",
        "first_name": "KELLY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-28",
        "last_updated": "2026-09-09",
        "certification_date": "2026-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "53228",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Rafael, CA

Sources for this page

Verify at the official NPI Registry.