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NPI Code Detail

MEDICARE: JON P KEA MD

MEDICARE: JON P KEA 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
1207R00000XInternal Medicine PhysicianA105566CA

General Provider Information

NPI Number : 1730577545
Entity Type Code : Organization
Provider Name (Legal Business Name) : JON P KEA MD
Provider Business Mailing Address
First Line : 325 N MAPLE DR
Second Line : #10144
City : BEVERLY HILLS
State : CA
Zip : 90213-4842
Country : US
Telephone Number : 310-421-8295
Fax Number :
Provider Business Practice Location Address
First Line : 325 N MAPLE DR
Second Line : #10144
City : BEVERLY HILLS
State : CA
Zip : 90213-4842
Country : US
Telephone Number : 310-421-8295
Fax Number :
Authorized Official
Title or Position : OWNER/PHYSICIAN
Name : MR. JON P KEA
Credential : MD
Telephone Number : 310-241-8295
Provider Enumeration Date : 12/31/2014
Last Update Date : 02/02/2015

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Directions to “JON P KEA MD ” Practice Location

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