Healthcare Provider Details

I. General information

NPI: 1508009655
Provider Name (Legal Business Name): JOHNNA LEE KEH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2009
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4955 VAN NUYS BLVD SUITE # 502
SHERMAN OAKS CA
91403-1801
US

IV. Provider business mailing address

4955 VAN NUYS BLVD SUITE # 502
SHERMAN OAKS CA
91403-1801
US

V. Phone/Fax

Practice location:
  • Phone: 818-325-0200
  • Fax: 818-325-0210
Mailing address:
  • Phone: 818-325-0200
  • Fax: 818-325-0210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA18700
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: