Provider Demographics
NPI:1235219031
Name:KEENE, DAVID HAL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HAL
Last Name:KEENE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:6330 SAN VICENTE BLVD STE 305
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5449
Mailing Address - Country:US
Mailing Address - Phone:323-525-0330
Mailing Address - Fax:323-525-0307
Practice Address - Street 1:6330 SAN VICENTE BLVD STE 305
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5449
Practice Address - Country:US
Practice Address - Phone:323-525-0330
Practice Address - Fax:323-525-0307
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG51024208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF01549Medicare UPIN