Kelly, Russell S

Kelly, Russell S is an sole proprietor health care provider with primary practice located at 91-2139 Fort Weaver Rd Suite 300, Ewa Beach HI 96706-3607. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Kelly, Russell S can be contacted via phone (808) 678-0700.

Contact Information

Primary practice address
91-2139 Fort Weaver Rd Suite 300 Ewa Beach HI 96706-3607
Phone: (808) 678-0700
Fax: (808) 678-0776
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 11807 Hawaii

Profile Details

NPI number 1790787729
LBN Legal business name Kelly, Russell S
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 10th, 2005
Last updated Feb 6th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790787729 NPPES
Hawaii MEDICAID 0000241885
Hawaii MEDICAID 539207

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