Organization
RUSSELL S KELLY MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL S KELLY M.D. (PHYSICIAN)
(808) 678-0700
Entity
Organization
Contact information
Practice address
91-2139 FORT WEAVER RD, SUITE 300, EWA BEACH, HI 96706-3607
(808) 678-0700
(808) 678-0776
Mailing address
91-2139 FORT WEAVER RD, SUITE 300, EWA BEACH, HI 96706-3607
(808) 678-0700
(808) 678-0776
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
11807
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000241885
—
HI
05
—
53920701
—
HI
Enumeration date
01/25/2007
Last updated
02/06/2008
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