Individual
KEVIN M. KELLY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5555 GROSSMONT CENTER DRIVE, LA MESA, CA 91942-3019
(619) 644-4401
Mailing address
PO BOX 12170, WESTMINSTER, CA 92685-2170
(877) 818-6102
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
A71711
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A717110
—
CA
05
—
A71711
—
CA
Enumeration date
06/27/2006
Last updated
08/26/2008
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