Provider Demographics
NPI:1730129214
Name:GURNICK, KEITH LOUIS (DPM)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:LOUIS
Last Name:GURNICK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 CENTURY PARK E
Mailing Address - Street 2:SUITE #705
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2001
Mailing Address - Country:US
Mailing Address - Phone:310-553-7691
Mailing Address - Fax:310-553-9542
Practice Address - Street 1:2080 CENTURY PARK E
Practice Address - Street 2:SUITE #705
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2001
Practice Address - Country:US
Practice Address - Phone:310-553-7691
Practice Address - Fax:310-553-9542
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2615213ES0103X
332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E2615000Medicaid
CA000E2615000OtherBLUE CROSS
CAP1737210OtherOXFORD
CA000E2615000Medicaid