Healthcare Provider Details

I. General information

NPI: 1669892295
Provider Name (Legal Business Name): KEREN L APPEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KEREN L DALLALZADEH

II. Dates (important events)

Enumeration Date: 04/22/2014
Last Update Date: 08/20/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W LA VETA AVE
ORANGE CA
92868-4203
US

IV. Provider business mailing address

300 COMMUNITY DR
MANHASSET NY
11030-3816
US

V. Phone/Fax

Practice location:
  • Phone: 714-509-4099
  • Fax: 714-509-4063
Mailing address:
  • Phone: 516-562-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA147603
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberA147603
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: