Individual
RUSSELL S KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
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
207R00000X
Internal Medicine Physician
Primary
11807
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000241885
—
HI
05
—
539207
—
HI
Enumeration date
08/10/2005
Last updated
02/06/2008
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