MARK JOSEPH KELLY (NPI# 1093889263) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093889263 |
| Entity Type | Individual |
| Full Name | MARK JOSEPH KELLY |
| Credential | MD |
| Practice Address |
2811 Wilshire Blvd Ste 810 Santa Monica CA 90403-4812 |
| Practice Telephone | 3108290039 |
| Practice Fax Number | 8887211105 |
| Mailing Telephone | 3108290039 |
| Mailing Fax Number | 3108281791 |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2020-02-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | G55252 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| INCORPORATION NPI | 1598827826 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356449755 | Mark Christopher Kelly | Physical Therapist | 1 Brace Rd Ste A, Cherry Hill, NJ 08034 | 2006-09-20 |
| 1760942403 | Mark Kelly | Student in an Organized Health Care Education/Training Program | 757 Westwood Plz, Los Angeles, CA 90095-8358 | 2019-03-20 |
| 1174027320 | Mark Kelly | Student in an Organized Health Care Education/Training Program | 677 Church Street, Attn: Gme, Marietta, GA 30060 | 2018-03-22 |
| 1366804742 | Mark Ryan Kelly | Counselor | 1908 N Laurent St, Suite 120, Victoria, TX 77901-5468 | 2016-03-24 |
| 1639300932 | Mark Kim Kelly | Radiology | 3707 New Vision Dr, Fort Wayne, IN 46845-1702 | 2009-08-04 |
| 1770641136 | Mark Kelly | Radiology | 25 N Winfield Road, Winfield, IL 60190 | 2006-12-05 |
| 1578656393 | Mark T Kelly | Dentist | 3637 Nw 39th St, Oklahoma City, OK 73112-6309 | 2006-10-02 |
| 1407958325 | Mark Paul Kelly | Clinical Neuropsychologist | 6900 Georgia Ave Nw, Walter Reed Army Medical Center, Washington, DC 20307-0003 | 2006-09-01 |
| 1457394090 | Mark Kelly | Emergency Medicine | 1220 Jefferson St, Laurel, MS 39440-4355 | 2006-06-13 |
| 1346294022 | Mark Edward Kelly | Anesthesiology | 2 Columbia Dr, Tampa, FL 33606-3508 | 2006-05-19 |
| Street Address |
2811 WILSHIRE BLVD STE 810 |
| City | SANTA MONICA |
| State | CA |
| Zip Code | 90403-4812 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033150123 | Martin Louis Alpert | Family Medicine | 2811 Wilshire Blvd Ste 810, Santa Monica, CA 90403 | 2006-06-09 |
| 1558531632 | Martin L. Alpert, M.d., Inc. | General Practice | 2811 Wilshire Blvd Ste 810, Santa Monica, CA 90403 | 2008-03-05 |
| 1174644942 | Alberto Saucedo | Radiology | 2811 Wilshire Blvd Ste 810, Santa Monica, CA 90403-4812 | 2007-04-02 |
| 1811018690 | Ross Eto | Radiology | 2811 Wilshire Blvd Ste 810, Santa Monica, CA 90403-4812 | 2007-04-02 |
| 1609997402 | Bradley A Jabour | Radiology | 2811 Wilshire Blvd Ste 810, Santa Monica, CA 90403-4812 | 2007-04-02 |
| 1437238839 | Ronald J. Hale | Dermatology | 2811 Wilshire Blvd Ste 810, Santa Monica, CA 90403 | 2006-11-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427520972 | Isobel Gardner | Marriage & Family Therapist | 2730 Wilshire Boulevard #650, Santa Monica, CA 90403 | 2018-12-21 |
| 1477030369 | Jennifer Garcia | Dentist | 2901 Wilshire Blvd Ste 255, Santa Monica, CA 90403 | 2018-07-23 |
| 1215435847 | The Balance Lab Physical Therapy and Fitness | Physical Therapist | 2924 Wilshire Blvd, Santa Monica, CA 90403 | 2018-01-29 |
| 1306354634 | Sea Change Santa Monica, Lp | Clinic/Center | 1051 Princeton St, Santa Monica, CA 90403 | 2018-01-22 |
| 1114446226 | Jafary Foot & Ankle Specialists LLC | Podiatrist | 2121 Wilshire Blvd Ste 101, Santa Monica, CA 90403 | 2017-09-11 |
| 1023553906 | Jory Faermark | Speech-Language Pathologist | 1158 26th Street, #417, Santa Monica, CA 90403 | 2016-12-30 |
| 1376095042 | William Michael Thornton | Chiropractor | 2118 Wilshire Blvd, #577, Santa Monica, CA 90403 | 2016-10-28 |
| 1801251723 | Lisa Lavoie | Naturopath | 1-935 Euclid St, Santa Monica, CA 90403 | 2015-12-18 |
| 1376915793 | Lisa Hanes | Marriage & Family Therapist | 1150 Yale Street, Suite 2, Santa Monica, CA 90403 | 2015-10-25 |
| 1386015386 | Natalie Kazarian | Marriage & Family Therapist | 2116 Wilshire Blvd Ste 241, Santa Monica, CA 90403 | 2015-10-15 |
| Find all providers in zip 90403 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154518629 | Mehran Movassaghi | Urology | 2001 Santa Monica Blvd Ste 460w, Santa Monica, CA 90404-2178 | 2007-09-28 |
| 1336181965 | Karyn S Eilber | Urology | 2020 Santa Monica Blvd., Suite 570, Santa Monica, CA 90404 | 2006-06-11 |
| 1912996851 | Martin K. Gelbard | Urology | 1260 15th St Ste 1200, Santa Monica, CA 90404-1147 | 2005-10-13 |
| 1922487800 | Jeannie Jiwon Su | Urology | 2121 Santa Monica Blvd, Santa Monica, CA 90404-2303 | 2015-05-25 |
| 1740628866 | Stanley Brosman Medical Corporation | Urology | 2021 Santa Monica Blvd, Suite 510, Santa Monica, CA 90404-2219 | 2013-06-11 |
| 1447503826 | Gregory Scott Jack | Urology | 1260 15th St, 1200, Santa Monica, CA 90404-1135 | 2012-10-22 |
| 1619248184 | Stacey C Carter | Urology | 1260 15th St, Suite 1200, Santa Monica, CA 90404-1135 | 2012-01-15 |
| 1770773269 | Dino T. Deconcini Md Inc | Urology | 2021 Santa Monica Blvd, 510 E, Santa Monica, CA 90404-2160 | 2007-07-31 |
| 1881891042 | Jennifer A Linehan | Urology | 2121 Santa Monica Blvd, Santa Monica, CA 90404-2303 | 2007-06-29 |
| 1538371679 | Zachery Chad Baxter | Urology | 1260 15th St Ste 1200, Santa Monica, CA 90404 | 2007-05-03 |
| Find all providers in SANTA MONICA | ||||
| City | SANTA MONICA |
| Zip Code | 90403 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.