MEDICARE: DR. KEITH JOSEPH YABLONICKY M.D.

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
1	208D00000X	General Practice Physician	A81617	CA
2	207P00000X	Emergency Medicine Physician	A81617	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861487969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH JOSEPH YABLONICKY M.D.

Provider Business Mailing Address
First Line	:	1200 N STATE ST
Second Line	:	EMERGENCY DEPARTMENT
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1029
Country	:	US
Telephone Number	:	323-226-6937
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 N STATE ST
Second Line	:	EMERGENCY DEPARTMENT
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1029
Country	:	US
Telephone Number	:	323-226-6937
Fax Number	:	323-226-6454

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	09/08/2009

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