Healthcare Provider Details

I. General information

NPI: 1376241919
Provider Name (Legal Business Name): KEYSTONE PSYCHIATRY SERVICES-INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10921 WILSHIRE BLVD STE 409B
LOS ANGELES CA
90024-4001
US

IV. Provider business mailing address

9736 YOAKUM DR
BEVERLY HILLS CA
90210-1436
US

V. Phone/Fax

Practice location:
  • Phone: 310-922-0584
  • Fax:
Mailing address:
  • Phone: 310-922-0584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JE DEUK KO
Title or Position: PRESIDENT
Credential: MD, PHD
Phone: 310-922-0584