Provider Demographics
NPI:1740708213
Name:PABAMM INC
Entity type:Organization
Organization Name:PABAMM INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:KEYME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-483-3540
Mailing Address - Street 1:550 HAMILTON AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2031
Mailing Address - Country:US
Mailing Address - Phone:310-483-3540
Mailing Address - Fax:
Practice Address - Street 1:550 HAMILTON AVE STE 320
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2031
Practice Address - Country:US
Practice Address - Phone:310-483-3540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA133422208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty