NPIMap

Organization Active NPI

Kay Kelly Traditional Chinese Medicine, Inc.

  • Clinic/Center
  • Plymouth, MN
National Provider Identifier
1992036883
Registry record updated Jan 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
1015 Issued in MN
Legal business name
KAY KELLY TRADITIONAL CHINESE MEDICINE, INC.
Practice address
12220 45TH Ave N
Plymouth, MN 55442-2443
Phone
(763) 213-9989
NPI assigned
Jan 17, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2010

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

Authorized official

Name
Kay Devine Kelly, L.AC.NPI 1417198300
Title
President
Phone
(763) 213-9989

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 1015 MN Primary

Addresses

Primary practice location

12220 45TH Ave N
Plymouth, MN 55442-2443

Mailing address

12220 45TH Ave N
Plymouth, MN 55442-2443
Phone (763) 213-9989

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1263686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263686400000",
    "number": "1992036883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12220 45TH AVE N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554422443",
            "telephone_number": "763-213-9989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12220 45TH AVE N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554422443",
            "telephone_number": "763-213-9989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAY KELLY TRADITIONAL CHINESE MEDICINE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-17",
        "last_updated": "2010-01-17",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "KAY",
        "authorized_official_middle_name": "DEVINE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "763-213-9989",
        "authorized_official_credential": "L.AC."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MN",
            "license": "1015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2010; 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.