Provider Demographics
NPI:1578366761
Name:PARIS, KAILEY CECILIA (MD)
Entity type:Individual
Prefix:DR
First Name:KAILEY
Middle Name:CECILIA
Last Name:PARIS
Suffix:
Gender:
Credentials:MD
Other - Prefix:DR
Other - First Name:KAILEY
Other - Middle Name:CECILIA
Other - Last Name:SHINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3835 OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3959
Mailing Address - Country:US
Mailing Address - Phone:310-780-9609
Mailing Address - Fax:
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:310-780-9609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program