MEDICARE: DR. PATRICK MICHAEL KELLY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	D66989	MD
2	2084P0804X	Child & Adolescent Psychiatry Physician	125168	CA

General Provider Information

NPI Number	:	1235275512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK MICHAEL KELLY MD

Provider Business Mailing Address
First Line	:	1230 ROSECRANS AVE STE 300
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-2494
Country	:	US
Telephone Number	:	424-269-0086
Fax Number	:	844-868-3841

Provider Business Practice Location Address
First Line	:	1230 ROSECRANS AVE STE 300
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-2494
Country	:	US
Telephone Number	:	424-269-0086
Fax Number	:	844-868-3841

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	01/04/2025

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