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General NPI Number Information
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NPI Number | 1881953909
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Entity Type | Organization
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Legal Business Name | BOUNMANY KYLE KEOJAMPA, MD
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Dates
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Enumeration Date | 05/09/2012
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Last Update Date | 03/11/2019
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Provider Practice Location Address
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Address Line | 19925 STEVENS CREEK BLVD STE 100
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City | CUPERTINO
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State | CA
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Zip | 95014-2384
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Country | US
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Telephone | 415-666-2525
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Fax | 888-857-4458
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Provider Business Mailing Address
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Address Line | 19925 STEVENS CREEK BLVD STE 100
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City | CUPERTINO
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State | CA
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Zip | 95014-2384
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Country | US
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Telephone | 415-666-2525
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Fax | 888-857-4458
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Authorized Official
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Title or Position | PHYSICIAN/SURGEON
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Name | DR. BOUNMANY KYLE KEOJAMPA
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Credential | M.D.
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Telephone | 415-666-2525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | 134756
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License Number State | CA
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