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General NPI Number Information
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NPI Number | 1447806096
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Entity Type | Organization
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Legal Business Name | STRAWBERRY CREEK MEDICAL GROUP OF CALIFORNIA PC
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Dates
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Enumeration Date | 08/09/2019
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 77 MORAGA WAY STE G
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City | ORINDA
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State | CA
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Zip | 94563-3019
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Country | US
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Telephone | 925-254-6710
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Fax |
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Provider Business Mailing Address
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Address Line | 77 MORAGA WAY STE G
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City | ORINDA
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State | CA
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Zip | 94563-3019
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Country | US
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Telephone | 833-880-7433
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Fax | 323-476-1971
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Authorized Official
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Title or Position | OWNER
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Name | DR. KANWAR KELLEY
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Credential | MD, JD
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Telephone | 833-880-7433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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