Provider Demographics
NPI:1376631119
Name:KEAN, ALLISON J (MD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:J
Last Name:KEAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 UCLA MEDICAL PLAZA
Mailing Address - Street 2:#630
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-6988
Mailing Address - Country:US
Mailing Address - Phone:310-794-1200
Mailing Address - Fax:310-794-1211
Practice Address - Street 1:100 UCLA MEDICAL PLAZA
Practice Address - Street 2:#630
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-6988
Practice Address - Country:US
Practice Address - Phone:310-794-1200
Practice Address - Fax:310-794-1211
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82982207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A829820Medicaid
CAWA82982BMedicare PIN
H88755Medicare UPIN