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NPI Code Detail

MEDICARE: WILLIAM KEITH HENRY

MEDICARE: WILLIAM KEITH HENRY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1175T00000XPeer SpecialistMPSS-GTUZKLCA

General Provider Information

NPI Number : 1689500647
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM KEITH HENRY
Provider Business Mailing Address
First Line : 131 N TUSTIN AVE STE 100
Second Line :
City : TUSTIN
State : CA
Zip : 92780-2937
Country : US
Telephone Number : 949-354-5435
Fax Number :
Provider Business Practice Location Address
First Line : 131 N TUSTIN AVE STE 100
Second Line :
City : TUSTIN
State : CA
Zip : 92780-2937
Country : US
Telephone Number : 949-354-5435
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2026
Last Update Date : 06/18/2026

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