Provider Demographics
NPI:1467809335
Name:HENKLER, KELLY CAMRYN (MD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:CAMRYN
Last Name:HENKLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 S LOS ANGELES ST APT 401
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-3780
Mailing Address - Country:US
Mailing Address - Phone:215-527-2886
Mailing Address - Fax:
Practice Address - Street 1:870 MARKET ST STE 415
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-3010
Practice Address - Country:US
Practice Address - Phone:415-926-5818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101268293207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine