Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 107728 | MN |
N | 207N00000X | Dermatologist | A155759 | CA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | A155759 | CA |
N | 207ND0900X | Dermatopathologist | 58373 | MN |
N | 207ND0900X | Dermatopathologist | A155759 | CA |
NPI | 1659702942 |
---|---|
Provider Name | Dr. Benjamin F Kelley |
First Address | San Diego, CA 92127-5705 |
Second Address | La Jolla, CA 92037-1036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2013 |
Last Update Date | 29/12/2020 |