MEDICARE: KELLY K MCCANN MD INC

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	208000000X	Pediatrics Physician	A101853	CA
2	207R00000X	Internal Medicine Physician	A101853	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	I12587	OTHER	OR	UPIN

General Provider Information

NPI Number	:	1750567244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KELLY K MCCANN MD INC

Provider Business Mailing Address
First Line	:	1831 ORANGE AVE STE C
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92627-2839
Country	:	US
Telephone Number	:	949-574-5800
Fax Number	:	949-612-2725

Provider Business Practice Location Address
First Line	:	1831 ORANGE AVE STE C
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92627-2839
Country	:	US
Telephone Number	:	949-574-5800
Fax Number	:	949-612-2725

Authorized Official
Title or Position	:	MD
Name	:	KELLY K MCCANN
Credential	:	MD
Telephone Number	:	949-574-5800

Provider Enumeration Date	:	01/14/2008
Last Update Date	:	02/28/2014

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Directions to “KELLY K MCCANN MD INC ” Practice Location

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