Provider Demographics
NPI:1972778843
Name:KEOJAMPA, BOUNMANY KYLE (MD)
Entity type:Individual
Prefix:DR
First Name:BOUNMANY
Middle Name:KYLE
Last Name:KEOJAMPA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4640 ADMIRALTY WAY
Mailing Address - Street 2:SUITE 718
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6621
Mailing Address - Country:US
Mailing Address - Phone:310-823-4444
Mailing Address - Fax:888-857-4458
Practice Address - Street 1:4640 ADMIRALTY WAY
Practice Address - Street 2:SUITE 718
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6621
Practice Address - Country:US
Practice Address - Phone:310-823-4444
Practice Address - Fax:888-857-4458
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2015-07-02
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Provider Licenses
StateLicense IDTaxonomies
MA242360207YS0123X
CA134756207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery