Provider Demographics
NPI:1295372621
Name:KEEBAN NAM, M.D., INC.
Entity type:Organization
Organization Name:KEEBAN NAM, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEEBAN
Authorized Official - Middle Name:CALEB
Authorized Official - Last Name:NAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-794-9725
Mailing Address - Street 1:1508 BARTON RD # 325
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-1410
Mailing Address - Country:US
Mailing Address - Phone:714-794-9725
Mailing Address - Fax:617-607-4064
Practice Address - Street 1:23141 MOULTON PKWY STE 213
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1204
Practice Address - Country:US
Practice Address - Phone:714-794-9725
Practice Address - Fax:617-607-4064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-04
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No273R00000XHospital UnitsPsychiatric Unit
No283Q00000XHospitalsPsychiatric Hospital
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)