Provider Demographics
NPI:1356393656
Name:KELLER, DAVID LOUIS (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LOUIS
Last Name:KELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1172
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-5172
Mailing Address - Country:US
Mailing Address - Phone:310-906-0651
Mailing Address - Fax:888-313-1539
Practice Address - Street 1:1948 ROLLING VISTA DR
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-3769
Practice Address - Country:US
Practice Address - Phone:310-896-5435
Practice Address - Fax:888-313-1539
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77409207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WG77409MMedicare ID - Type UnspecifiedMEDICARE PPIN
G45713Medicare UPIN
CAWG77409BMedicare UPIN