Provider Demographics
NPI:1417154790
Name:BAYAN, KEITH ROBIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ROBIN
Last Name:BAYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16550 VENTURA BLVD
Mailing Address - Street 2:SUITE 414
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2004
Mailing Address - Country:US
Mailing Address - Phone:818-783-3110
Mailing Address - Fax:818-783-3115
Practice Address - Street 1:1000 N SEPULVEDA BLVD STE 190
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-5974
Practice Address - Country:US
Practice Address - Phone:310-546-8702
Practice Address - Fax:310-545-5310
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA93872208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics