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General NPI Number Information
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NPI Number | 1295372621
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Entity Type | Organization
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Legal Business Name | KEEBAN NAM, M.D., INC.
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Dates
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Enumeration Date | 12/04/2019
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Last Update Date | 01/17/2023
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Provider Practice Location Address
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Address Line | 23141 MOULTON PKWY STE 213
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-1204
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Country | US
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Telephone | 714-794-9725
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Fax | 617-607-4064
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Provider Business Mailing Address
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Address Line | 1508 BARTON RD # 325
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City | REDLANDS
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State | CA
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Zip | 92373-1410
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Country | US
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Telephone | 714-794-9725
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Fax | 617-607-4064
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEEBAN CALEB NAM
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Credential | MD
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Telephone | 714-794-9725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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