Provider Demographics
NPI:1336438670
Name:KELLEY, KANWAR SINGH (MD, JD)
Entity type:Individual
Prefix:DR
First Name:KANWAR
Middle Name:SINGH
Last Name:KELLEY
Suffix:
Gender:M
Credentials:MD, JD
Other - Prefix:
Other - First Name:KANWARJIT
Other - Middle Name:SINGH
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:77 MORAGA WAY STE G
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-3019
Mailing Address - Country:US
Mailing Address - Phone:925-254-6710
Mailing Address - Fax:925-254-6713
Practice Address - Street 1:77 MORAGA WAY STE G
Practice Address - Street 2:
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563
Practice Address - Country:US
Practice Address - Phone:925-254-6710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA123114207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA842637791Medicaid