Wayne J Kelly MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

WAYNE J KELLY MD

Practice address

301 E Florida Ave Ste E
Hemet, CA 92543-4253

Phone

(951) 929-2753

NPI assigned

Feb 19, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Wayne J Kelly, MD

Title

Owner

Phone

(951) 929-2753

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1203379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222128000000",
    "number": "1487822805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 E FLORIDA AVE STE E",
            "city": "HEMET",
            "state": "CA",
            "postal_code": "925434253",
            "telephone_number": "951-929-2753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 E FLORIDA AVE STE E",
            "city": "HEMET",
            "state": "CA",
            "postal_code": "925434253",
            "telephone_number": "951-929-2753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYNE J KELLY MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-19",
        "last_updated": "2008-09-23",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "951-929-2753",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0079650",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Hemet, CA
• Providers in Hemet, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.