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1134224843

NPI Code Detail

MEDICARE: DR. KEKOA CHRISTIAN EDE MD

MEDICARE: DR. KEKOA CHRISTIAN EDE MD

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	A101211	CA
2	207R00000X	Internal Medicine Physician	MD-12408	HI
3	207R00000X	Internal Medicine Physician	A101211	CA
4	2084P0800X	Psychiatry Physician	MD-12408	HI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W14158	OTHER	CA	SITE MEDICARE NUMBER
2	ZZZ20041Z	OTHER	CA	SITE MEDICARE NUMBER

General Provider Information

NPI Number	:	1134224843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEKOA CHRISTIAN EDE MD

Provider Business Mailing Address
First Line	:	488 E VALLEY PKWY STE 311
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92025-3374
Country	:	US
Telephone Number	:	760-520-8100
Fax Number	:	760-737-2039

Provider Business Practice Location Address
First Line	:	488 E VALLEY PKWY STE 311
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92025-3374
Country	:	US
Telephone Number	:	760-520-8100
Fax Number	:

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	03/06/2026

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Directions to “ DR. KEKOA CHRISTIAN EDE MD” Practice Location

Language	Start Address	Practice Location

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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