Raymond J Kelly, M.D. Inc

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

G 023921 Issued in CA

Legal business name

RAYMOND J KELLY, M.D. INC

Practice address

100 S Ellsworth Ave
Suite 301
San Mateo, CA 94401-3939

Phone

(650) 344-2561

Fax

(650) 344-2563

NPI assigned

Oct 12, 2007

Last updated

Oct 23, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Raymond J Kelly

Title

Owner/Ceo

Phone

(650) 344-2561

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1192147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193097600000",
    "number": "1598953739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 S ELLSWORTH AVE",
            "address_2": "SUITE 301",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944013939",
            "telephone_number": "650-344-2561",
            "fax_number": "650-344-2563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 S ELLSWORTH AVE",
            "address_2": "SUITE 301",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944013939",
            "telephone_number": "650-344-2561",
            "fax_number": "650-344-2563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAYMOND J KELLY, M.D. INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-12",
        "last_updated": "2007-10-23",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "650-344-2561",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": "CA",
            "license": "G 023921",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 1 NPI",
            "identifier": "1356409239",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LISCENSE",
            "identifier": "G 023921",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Otolaryngology Physician in San Mateo, CA
• Providers in San Mateo, CA by specialty
• Otolaryngology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2007; 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.