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General NPI Number Information
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NPI Number | 1154318830
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Entity Type | Individual
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Provider Name | LARRY ALAN KEAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/29/2005
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Last Update Date | 04/03/2015
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Provider Practice Location Address
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Address Line | 2500 ALHAMBRA AVE
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City | MARTINEZ
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State | CA
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Zip | 94553-3156
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Country | US
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Telephone | 704-671-5344
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Fax | 704-671-5331
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Provider Business Mailing Address
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Address Line | 2240 REMOUNT RD
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City | GASTONIA
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State | NC
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Zip | 28054-4725
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Country | US
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Telephone | 704-671-5311
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Fax | 704-671-5308
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 200500068
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License Number State | NC
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