Provider Demographics
NPI:1477678019
Name:KELLEY, JOHN GEORGE (MD,MS)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:GEORGE
Last Name:KELLEY
Suffix:
Gender:M
Credentials:MD,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 320806
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-0113
Mailing Address - Country:US
Mailing Address - Phone:408-356-7464
Mailing Address - Fax:408-356-5150
Practice Address - Street 1:555 KNOWLES DR
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1549
Practice Address - Country:US
Practice Address - Phone:408-356-7464
Practice Address - Fax:408-356-5150
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46369207LA0401X, 207LC0200X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
Not Answered207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine