Provider Demographics
NPI:1932126653
Name:CHUMLEY, KEITH (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:CHUMLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3701 SKYPARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4712
Mailing Address - Country:US
Mailing Address - Phone:310-378-2234
Mailing Address - Fax:310-378-9795
Practice Address - Street 1:23600 TELO AVE STE 280
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4037
Practice Address - Country:US
Practice Address - Phone:424-250-9979
Practice Address - Fax:310-378-9795
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD11595207Q00000X
CAC137279207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI99017685996793B014OtherTRICARE - CHAMPUS
HI229609OtherHMSA - 65CP- HMSA QUEST
HI247043OtherUHA
HI99017685996793B014OtherTRICARE - CHAMPUS
HI229609OtherHMSA - 65CP- HMSA QUEST