Organization
RAYMOND J KELLY, M.D. INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAYMOND J KELLY (OWNER/CEO)
(650) 344-2561
Entity
Organization
Contact information
Practice address
100 S ELLSWORTH AVE, SUITE 301, SAN MATEO, CA 94401-3939
(650) 344-2561
(650) 344-2563
Mailing address
100 S ELLSWORTH AVE, SUITE 301, SAN MATEO, CA 94401-3939
(650) 344-2561
(650) 344-2563
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
G 023921
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1356409239
TYPE 1 NPI
CA
01
—
G 023921
LISCENSE
CA
Enumeration date
10/12/2007
Last updated
10/23/2007
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