Provider Demographics
NPI:1376241919
Name:KEYSTONE PSYCHIATRY SERVICES-INC
Entity Type:Organization
Organization Name:KEYSTONE PSYCHIATRY SERVICES-INC
Other - Org Name:WESTWOOD MINDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JE
Authorized Official - Middle Name:DEUK
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:310-920-2016
Mailing Address - Street 1:6200 HOLLYWOOD BLVD APT 2628
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-6378
Mailing Address - Country:US
Mailing Address - Phone:310-920-2016
Mailing Address - Fax:
Practice Address - Street 1:10921 WILSHIRE BLVD STE 409B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4001
Practice Address - Country:US
Practice Address - Phone:310-920-2016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-22
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Multi-Specialty
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic PsychiatryGroup - Multi-Specialty