Healthcare Provider Details

I. General information

NPI: 1598708240
Provider Name (Legal Business Name): G.K EDWARDS M.D APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1328 TWENTY SECOND STREET
SANTA MONICA CA
90404
US

IV. Provider business mailing address

2353 PROSSER AVE
LOS ANGELES CA
90064-2323
US

V. Phone/Fax

Practice location:
  • Phone: 310-449-1188
  • Fax:
Mailing address:
  • Phone: 310-449-1188
  • Fax: 310-449-9136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberG59625
License Number StateCA

VIII. Authorized Official

Name: DR. GEORGE KEITH EDWARDS
Title or Position: M.D.
Credential:
Phone: 310-449-1188