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General NPI Number Information
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NPI Number | 1376778167
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Entity Type | Organization
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Legal Business Name | MARSHALL JAY KEYES M D A MEDICAL CORPORATION
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Dates
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Enumeration Date | 05/21/2009
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Last Update Date | 05/21/2009
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Provider Practice Location Address
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Address Line | 1964 WESTWOOD BLVD STE 110
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City | LOS ANGELES
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State | CA
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Zip | 90025-4683
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Country | US
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Telephone | 310-446-1822
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Fax | 310-446-1362
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Provider Business Mailing Address
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Address Line | 1964 WESTWOOD BLVD STE 110
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City | LOS ANGELES
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State | CA
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Zip | 90025-4683
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Country | US
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Telephone | 310-446-1822
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Fax | 310-446-1362
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Authorized Official
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Title or Position | PRES.
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Name | DR. MARSHALL JAY KEYES
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Credential | MD
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Telephone | 310-446-1822
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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 | G26695
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License Number State | CA
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