Provider Demographics
NPI:1285755496
Name:WILLIAM DANIEL KEITH JR MD INC
Entity type:Organization
Organization Name:WILLIAM DANIEL KEITH JR MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:323-932-0382
Mailing Address - Street 1:6200 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 1111
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5801
Mailing Address - Country:US
Mailing Address - Phone:323-932-0382
Mailing Address - Fax:323-932-0653
Practice Address - Street 1:6200 WILSHIRE BLVD
Practice Address - Street 2:SUITE 1111
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048
Practice Address - Country:US
Practice Address - Phone:323-932-0382
Practice Address - Fax:323-932-0653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW854AMedicare ID - Type Unspecified