Healthcare Provider Details

I. General information

NPI: 1972609352
Provider Name (Legal Business Name): MATTHEW S KEEFER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
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: 323-669-2534
  • Fax: 323-663-6707
Mailing address:
  • Phone: 323-669-2337
  • Fax: 323-644-8488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA74609
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: