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NPI Code Detail

MEDICARE: KEENAN BLAKE WITHERS

MEDICARE: KEENAN BLAKE WITHERS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianA193293CA

General Provider Information

NPI Number : 1093392615
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEENAN BLAKE WITHERS
Provider Business Mailing Address
First Line : 760 WESTWOOD PLZ STE 37-384
Second Line :
City : LOS ANGELES
State : CA
Zip : 90024-5055
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5419 W SUNSET BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90027-5691
Country : US
Telephone Number : 323-769-6100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2021
Last Update Date : 02/13/2026

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Directions to “ KEENAN BLAKE WITHERS ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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