Provider Demographics
NPI:1245269984
Name:KE, MALCOLM (MD)
Entity type:Individual
Prefix:
First Name:MALCOLM
Middle Name:
Last Name:KE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3704
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-1704
Mailing Address - Country:US
Mailing Address - Phone:424-206-1406
Mailing Address - Fax:424-206-1406
Practice Address - Street 1:23456 HAWTHORNE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4752
Practice Address - Country:US
Practice Address - Phone:310-540-5272
Practice Address - Fax:310-540-5271
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA73403207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000523164OtherANTHEM
OH221410OtherUNISON
OHP00333086OtherRAILROAD MEDICARE
CA00A734030Medicaid
OH2673530Medicaid
OH7190699OtherAETNA
OHKE4188992Medicare Oscar/Certification
OHP00333086OtherRAILROAD MEDICARE
OHKE4188991Medicare ID - Type Unspecified
OH221410OtherUNISON