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Organization
KAE KELLY SURGICAL INC
Active
Organization
KAE KELLY SURGICAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SYLVANUS OYOGOA MD (OWNER)
(410) 598-5707
Entity
Organization
Contact information
Practice address
1828 HARPER RD, BECKLEY, WV 25801-3366
(304) 253-5690
Mailing address
1038 N. EISENHOWER DR, PMB 286, BECKLEY, WV 25801
(304) 253-5690
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
NULL
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1801863139
NPI
—
Enumeration date
01/25/2017
Last updated
03/21/2018
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