Provider Demographics
NPI:1346553427
Name:SOMSANITH, KEITH AARON J (DO)
Entity Type:Individual
Prefix:
First Name:KEITH AARON
Middle Name:J
Last Name:SOMSANITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:KEITH
Other - Middle Name:
Other - Last Name:SOMSANITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:10650 REAGAN ST
Mailing Address - Street 2:276
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-8800
Mailing Address - Country:US
Mailing Address - Phone:408-657-6286
Mailing Address - Fax:
Practice Address - Street 1:9436 SLAUSON AVE
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-4748
Practice Address - Country:US
Practice Address - Phone:562-949-6069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10703207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine