Provider Demographics
NPI:1902867419
Name:KELSEY, CHRISTOPHER STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:STEVEN
Last Name:KELSEY
Suffix:
Gender:M
Credentials:MD
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 310
Mailing Address - Street 2:
Mailing Address - City:CARDIFF BY THE SEA
Mailing Address - State:CA
Mailing Address - Zip Code:92007
Mailing Address - Country:US
Mailing Address - Phone:858-651-5918
Mailing Address - Fax:858-651-5953
Practice Address - Street 1:5775 MOREHOUSE DRIVE
Practice Address - Street 2:SUITE S-274
Practice Address - City:SAN DIEGA
Practice Address - State:CA
Practice Address - Zip Code:92121
Practice Address - Country:US
Practice Address - Phone:858-651-5918
Practice Address - Fax:858-651-5953
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG67240207Q00000X
IDM5536207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
R15058Medicare UPIN