Provider Demographics
NPI:1821125071
Name:YOUNG, KEITH WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:WILLIAM
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10780 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4749
Mailing Address - Country:US
Mailing Address - Phone:310-475-7911
Mailing Address - Fax:310-475-1669
Practice Address - Street 1:10780 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4749
Practice Address - Country:US
Practice Address - Phone:310-475-7911
Practice Address - Fax:310-475-1669
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA0530632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry