Provider Demographics
NPI:1700374469
Name:SPECTOR, KELLIE D (MD)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:D
Last Name:SPECTOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8700 BEVERLY BLVD STE 5512
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1804
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:363 S MAIN ST # 485
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3813
Practice Address - Country:US
Practice Address - Phone:714-835-4800
Practice Address - Fax:714-835-1900
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA165496207RH0003X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology