Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kelly Green Mazurek, MD

Individual provider Nephrology Physician · NPI 1487915203

Kelly Green Mazurek, MD is an Internal Medicine in San Diego, California. Qualified in 2012, 14 years ago. Practices with Southern California Permanente Medical Group, an 11,242-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in California.

Years since qualifying
14
Licensed in
CA
In the registry since
2012
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

4510 Viewridge Ave
San Diego, CA 92123
Phone: (866) 413-1582
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 263 Farmington Ave, Farmington, CT 06030-0001 — (860) 679-2147

Specialties & licences

Nephrology Physician (primary) Taxonomy 207RN0300X · Licence A149649 (CA)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1487915203
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorYes
NPI enumeratedJune 7, 2012
Last updated in NPPESNovember 29, 2021
Certification dateNovember 29, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyINTERNAL MEDICINE
Also practisesNEPHROLOGY
Medical schoolOTHER
Graduated 2012 (14 years in practice)
Group practice Southern California Permanente Medical Group — 11242 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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