Healthcare Provider Details

I. General information

NPI: 1629212162
Provider Name (Legal Business Name): JEFFREY KECHES BA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 04/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9150 IMPERIAL HWY RM P-31
DOWNEY CA
90242-2835
US

IV. Provider business mailing address

1330 W IMPERIAL HWY
LOS ANGELES CA
90044-1320
US

V. Phone/Fax

Practice location:
  • Phone: 562-940-3694
  • Fax: 562-658-7425
Mailing address:
  • Phone: 323-241-5865
  • Fax: 323-755-6677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: