Provider Demographics
NPI:1124115639
Name:KELLY, DANIEL PATRICK (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:PATRICK
Last Name:KELLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:45 CASTRO STREET
Mailing Address - Street 2:SUITE 232
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1027
Mailing Address - Country:US
Mailing Address - Phone:415-565-6810
Mailing Address - Fax:415-565-6844
Practice Address - Street 1:45 CASTRO STREET
Practice Address - Street 2:SUITE 232
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1027
Practice Address - Country:US
Practice Address - Phone:415-565-6810
Practice Address - Fax:415-565-6844
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2013-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG46390208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G463900Medicaid
F80042Medicare UPIN