Healthcare Provider Details

I. General information

NPI: 1134784572
Provider Name (Legal Business Name): SHIVANI J KESHAV DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8514 PARAMOUNT BLVD
DOWNEY CA
90240-2169
US

IV. Provider business mailing address

218 E GRAND AVE APT 601
CHICAGO IL
60611-3882
US

V. Phone/Fax

Practice location:
  • Phone: 909-895-9052
  • Fax:
Mailing address:
  • Phone: 909-895-9052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019.036770
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number021.003503
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number104623
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: