Provider Demographics
NPI:1508925900
Name:KELLY AND SAADE PEDIATRICS MEDICAL CORPORATION
Entity Type:Organization
Organization Name:KELLY AND SAADE PEDIATRICS MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:DUDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-776-3444
Mailing Address - Street 1:8337 TELEGRAPH RD STE 119
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-4941
Mailing Address - Country:US
Mailing Address - Phone:562-776-3444
Mailing Address - Fax:562-776-3411
Practice Address - Street 1:8337 TELEGRAPH RD STE 119
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-4941
Practice Address - Country:US
Practice Address - Phone:562-776-3444
Practice Address - Fax:562-776-3411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39942174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1295795409OtherGEORGE A SAADE MD
CA1588624084OtherDAVID J. KELLY MD
CA1295795409OtherGEORGE A SAADE MD
CA00G406960Medicare ID - Type UnspecifiedGEORGE A SAADE MD
CA1588624084OtherDAVID J. KELLY MD
CAA48318Medicare UPIN