Healthcare Provider Details

I. General information

NPI: 1609948843
Provider Name (Legal Business Name): TIMOTHY F. KELLEY, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SUPERIOR AVE STE 315
NEWPORT BEACH CA
92663-3667
US

IV. Provider business mailing address

PO BOX 2975
SUISUN CITY CA
94585-5975
US

V. Phone/Fax

Practice location:
  • Phone: 949-645-3223
  • Fax: 949-645-3222
Mailing address:
  • Phone: 657-241-3600
  • Fax: 657-241-7708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY F KELLEY
Title or Position: OWNER
Credential:
Phone: 949-645-3223