Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | G31654 | CA |
NPI | 1023109675 |
---|---|
Provider Name | Dr. Kimberly Kelly |
First Address | Los Angeles, CA 90012-3328 |
Second Address | Los Angeles, CA 90012-3328 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 08/07/2007 |