Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | A88790 | CA |
NPI | 1134236623 |
---|---|
Provider Name | Thomas Gerald Kelly |
First Address | San Diego, CA 92103-2213 |
Second Address | San Diego, CA 92103-2213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 02/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A887900 | (05) | CA |