Provider Demographics
NPI:1225350069
Name:MALCOLM KE, M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MALCOLM KE, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:CLEAR DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:
Authorized Official - Last Name:KE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:424-206-1406
Mailing Address - Street 1:23456 HAWTHORNE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4752
Mailing Address - Country:US
Mailing Address - Phone:310-540-5272
Mailing Address - Fax:310-540-5271
Practice Address - Street 1:23456 HAWTHORNE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4752
Practice Address - Country:US
Practice Address - Phone:310-540-5272
Practice Address - Fax:310-540-5271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-21
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty