MEDICARE: DR. KEEBAN CALEB NAM M.D.

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
1	2084P0800X	Psychiatry Physician	A140587	CA
2	2084P0804X	Child & Adolescent Psychiatry Physician	A140587	CA

General Provider Information

NPI Number	:	1114347333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEEBAN CALEB NAM M.D.

Provider Business Mailing Address
First Line	:	23141 MOULTON PKWY STE 213
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-1204
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	23141 MOULTON PKWY STE 213
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-1204
Country	:	US
Telephone Number	:	949-258-3741
Fax Number	:	949-258-3742

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2014
Last Update Date	:	07/09/2021

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