Provider Demographics
NPI:1609829415
Name:KEIPP, JOHN A (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:KEIPP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:DEPT. LA 23039
Mailing Address - Street 2:ATTENTION: MAGGIE NOLES MS 6160
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91185-3039
Mailing Address - Country:US
Mailing Address - Phone:562-741-4461
Mailing Address - Fax:562-741-4413
Practice Address - Street 1:12900 PARK PLAZA DRIVE # 150
Practice Address - Street 2:ATTENTION: MAGGIE NOLES MS 6160
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-9329
Practice Address - Country:US
Practice Address - Phone:562-622-2800
Practice Address - Fax:562-622-2898
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA22945207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A23322Medicare UPIN