Kelly Mah, M.D.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

G065156 Issued in CA

Legal business name

KELLY MAH, M.D.

Doing business as

Manteca Obstetrics and Gynecology Medical Group

Practice address

421 E Center St
Manteca, CA 95336-4718

Phone

(209) 823-7616

Fax

(209) 823-4352

NPI assigned

Sep 25, 2006

Organization subpart

No

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

Authorized official

Name

Kelly Mah, M.D.NPI 1053420489

Title

President

Phone

(209) 823-7616

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Manteca Obstetrics and Gynecology Medical Group Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kelly Mah, M.D.

  • Obstetrics & Gynecology Physician
  • Manteca, CA
  • NPI 1053420489
  NPD (past) Authorized official

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1477654341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 E CENTER ST",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953364718",
            "telephone_number": "209-823-7616",
            "fax_number": "209-823-4352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 E CENTER ST",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953364718",
            "telephone_number": "209-823-7616",
            "fax_number": "209-823-4352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY MAH, M.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-25",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "MAH",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-823-7616",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "G065156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE NUMBER",
            "identifier": "G065156",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0045320",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Manteca Obstetrics and Gynecology Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Alicia Keener
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• El Rasheed Khalifa, DDS
• Kerolos George Khalil, DDS
• Abdul Waheed Khan, M.D.

• Obstetrics & Gynecology Physician in Manteca, CA
• Providers in Manteca, CA by specialty
• Obstetrics & Gynecology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.