Healthcare Provider Details

I. General information

NPI: 1700988680
Provider Name (Legal Business Name): KENNETH ALLEN GELLER M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

6430 W SUNSET BLVD SUITE 600
LOS ANGELES CA
90028-7901
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-2145
  • Fax: 323-664-7327
Mailing address:
  • Phone: 323-361-2145
  • Fax: 323-664-7327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberG26159
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: