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General NPI Number Information
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NPI Number | 1225334360
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Entity Type | Organization
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Legal Business Name | KEITH EARL KENYON JR MD INC
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Dates
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Enumeration Date | 02/08/2011
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Last Update Date | 02/08/2011
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Provider Practice Location Address
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Address Line | 201 S ALVARADO ST SUITE 406
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City | LOS ANGELES
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State | CA
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Zip | 90057-2320
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Country | US
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Telephone | 213-483-2416
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Fax | 213-483-8211
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Provider Business Mailing Address
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Address Line | 201 S ALVARADO ST SUITE 406
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City | LOS ANGELES
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State | CA
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Zip | 90057-2320
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Country | US
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Telephone | 213-483-2416
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Fax | 213-483-8211
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEITH EARL KENYON JR.
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Credential | M.D.
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Telephone | 213-483-2416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | G30715
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License Number State | CA
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