Healthcare Provider Details

I. General information

NPI: 1003556234
Provider Name (Legal Business Name): NIVEDITA KESHAV MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 REDWOOD HWY RD STE 5215
MILL VALLEY CA
94941-3016
US

IV. Provider business mailing address

757 WESTWOOD PLAZA BOX 951752, 3108 RRUMC
LOS ANGELES CA
90095-1752
US

V. Phone/Fax

Practice location:
  • Phone: 415-381-5400
  • Fax:
Mailing address:
  • Phone: 310-267-9132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA189166
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: