Healthcare Provider Details

I. General information

NPI: 1285591024
Provider Name (Legal Business Name): KEVIN MICHAEL KEEGAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 N ANAHEIM BLVD
ANAHEIM CA
92805-2651
US

IV. Provider business mailing address

710 N ANAHEIM BLVD
ANAHEIM CA
92805-2651
US

V. Phone/Fax

Practice location:
  • Phone: 714-776-7490
  • Fax: 657-276-9041
Mailing address:
  • Phone: 714-776-7490
  • Fax: 657-276-9041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: