Provider Demographics
NPI:1740381177
Name:GARB, KEITH S (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:S
Last Name:GARB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:26585 AGOURA RD STE 330
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1958
Practice Address - Country:US
Practice Address - Phone:818-876-1050
Practice Address - Fax:818-876-1026
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54512207RA0201X, 207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G545120OtherBLUE SHIELD
CAWG54512FMedicare ID - Type Unspecified
CA00G545120OtherBLUE SHIELD
CAWG54512HMedicare ID - Type Unspecified
CAWG54512EMedicare ID - Type Unspecified
E21628Medicare UPIN