Provider Demographics
NPI:1528114410
Name:WORTHAM, JAMES KELLER (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:KELLER
Last Name:WORTHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 MONTEREY BLVD
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-2905
Mailing Address - Country:US
Mailing Address - Phone:213-700-8488
Mailing Address - Fax:
Practice Address - Street 1:1030 S GLENDALE AVE
Practice Address - Street 2:SUITE 503
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-5612
Practice Address - Country:US
Practice Address - Phone:818-547-5400
Practice Address - Fax:818-547-3380
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88510208D00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine