# KAE KELLY SURGICAL INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992242184
- **Authorized official:** SYLVANUS OYOGOA MD (OWNER)
- **Authorized official phone:** (410) 598-5707

## Contact information

- **Practice address:** 1828 HARPER RD, BECKLEY, WV 25801-3366
- **Practice address phone:** (304) 253-5690
- **Mailing address:** 1038 N. EISENHOWER DR, PMB 286, BECKLEY, WV 25801
- **Mailing address phone:** (304) 253-5690

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/25/2017
- **Last updated:** 03/21/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1801863139 | NPI | — |