Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 59461 | CA |
Y | 1223P0700X | Prosthodontist | 59461 | CA |
N | 1223P0700X | Prosthodontist | 6741 | NE |
NPI | 1184879983 |
---|---|
Provider Name | Dr. James Aaron Kelly |
First Address | Los Angeles, CA 90095-1668 |
Second Address | Los Angeles, CA 90095-1668 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2008 |
Last Update Date | 07/09/2010 |