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General NPI Number Information
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NPI Number | 1912174731
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Entity Type | Individual
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Provider Name | MR. MICHAEL JASON KELLEY
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Gender | Male
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Dates
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Enumeration Date | 05/12/2008
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Last Update Date | 07/03/2008
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Provider Practice Location Address
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Address Line | 1209 HEATHERVIEW DR
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City | OAK PARK
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State | CA
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Zip | 91377-3914
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Country | US
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Telephone | 818-879-8037
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Fax |
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Provider Business Mailing Address
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Address Line | 1209 HEATHERVIEW DR
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City | OAK PARK
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State | CA
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Zip | 91377-3914
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Country | US
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Telephone | 818-879-8037
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471C3402X
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Taxonomy Name | Radiography Radiologic Technologist
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License Number |
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License Number State |
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