Provider Demographics
NPI:1114347333
Name:NAM, KEEBAN CALEB (MD)
Entity Type:Individual
Prefix:DR
First Name:KEEBAN
Middle Name:CALEB
Last Name:NAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23141 MOULTON PKWY STE 213
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1204
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23141 MOULTON PKWY STE 213
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1204
Practice Address - Country:US
Practice Address - Phone:949-258-3741
Practice Address - Fax:949-258-3742
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-28
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA1405872084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry