Provider Demographics
NPI:1699807065
Name:KILLEEN, KELLY LYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:LYNNE
Last Name:KILLEEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:436 N BEDFORD DR STE 103
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4323
Mailing Address - Country:US
Mailing Address - Phone:310-278-8200
Mailing Address - Fax:310-278-8230
Practice Address - Street 1:436 N BEDFORD DR STE 103
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4323
Practice Address - Country:US
Practice Address - Phone:310-278-8200
Practice Address - Fax:310-278-8230
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA92060208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery