MEDICARE: DR. KELLY LAW DO

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	207Q00000X	Family Medicine Physician	20A20679	CA

General Provider Information

NPI Number	:	1316525587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY LAW DO

Provider Business Mailing Address
First Line	:	1443 OCEAN AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94112-1731
Country	:	US
Telephone Number	:	415-391-9686
Fax Number	:

Provider Business Practice Location Address
First Line	:	1443 OCEAN AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94112-1731
Country	:	US
Telephone Number	:	415-391-9686
Fax Number	:

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

Provider Enumeration Date	:	03/30/2021
Last Update Date	:	08/12/2024

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Directions to “ DR. KELLY LAW DO” Practice Location

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