Provider Demographics
NPI:1134795719
Name:KEYO, KEVORK (DDS)
Entity type:Individual
Prefix:DR
First Name:KEVORK
Middle Name:
Last Name:KEYO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11014 FRUITLAND DR
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-3541
Mailing Address - Country:US
Mailing Address - Phone:818-480-8358
Mailing Address - Fax:
Practice Address - Street 1:11014 FRUITLAND DR
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-3541
Practice Address - Country:US
Practice Address - Phone:818-480-8358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1061901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice