Provider Demographics
NPI:1932390051
Name:WRIGHT, KELLY N (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:N
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 S SAN VICENTE BLVD STE 1003
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4166
Mailing Address - Country:US
Mailing Address - Phone:310-423-9268
Mailing Address - Fax:
Practice Address - Street 1:444 S SAN VICENTE BLVD STE 1003
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4166
Practice Address - Country:US
Practice Address - Phone:310-423-9268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA246580207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110088949AMedicaid
MA002827101Medicare PIN