Provider Demographics
NPI:1326479569
Name:KEEKEEBHAI, ISMAIL EBRAHIM
Entity Type:Individual
Prefix:DR
First Name:ISMAIL
Middle Name:EBRAHIM
Last Name:KEEKEEBHAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3834 TILDEN AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-3940
Mailing Address - Country:US
Mailing Address - Phone:310-621-2807
Mailing Address - Fax:
Practice Address - Street 1:300 N CANON DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4705
Practice Address - Country:US
Practice Address - Phone:310-621-2807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48849183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist