Kelly, Kevin M.

Kelly, Kevin M. is an individual health care provider with primary practice located at 5555 Grossmont Center Drive , La Mesa CA 91942-3019. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Kelly, Kevin M. can be contacted via phone (619) 644-4401.

Contact Information

Primary practice address
5555 Grossmont Center Drive La Mesa CA 91942-3019
Phone: (619) 644-4401
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X A71711 California

Profile Details

NPI number 1811924764
LBN Legal business name Kelly, Kevin M.
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 27th, 2006
Last updated Aug 26th, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1811924764 NPPES
California MEDICAID A71711
California MEDICAID 00A717110

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