Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kelly Phommahaxay, MD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1770997173

Kelly Phommahaxay, MD is a Family Practice in LA Mesa, California. Qualified in 2014, 12 years ago. Practices with Southern California Permanente Medical Group, an 11,242-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
12
Licensed in
MN
In the registry since
2014
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

8080 Parkway Dr
LA Mesa, CA 91942-2104
Phone: (619) 753-5115
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 330 N 8th Ave E, Duluth, MN 55805-2024 — (218) 723-1112
  • 1039 Montgomery St, Custer, SD 57730-1304 — (605) 673-2229

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 59533 (MN)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1770997173
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedJune 13, 2014
Last updated in NPPESJanuary 18, 2024
Certification dateJanuary 18, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Southern California Permanente Medical Group — 11242 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in LA Mesa