Provider Demographics
NPI:1780028464
Name:KELLY, ERIN SHIGEKO (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:SHIGEKO
Last Name:KELLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2708 GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-4032
Mailing Address - Country:US
Mailing Address - Phone:310-291-4154
Mailing Address - Fax:310-425-3127
Practice Address - Street 1:2708 GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-4032
Practice Address - Country:US
Practice Address - Phone:310-291-4154
Practice Address - Fax:310-425-3127
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87254208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice