Provider Demographics
NPI:1144592783
Name:EMMONS, KEITH ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ALLEN
Last Name:EMMONS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:865 COMSTOCK AVE
Mailing Address - Street 2:UNIT 3B
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-2572
Mailing Address - Country:US
Mailing Address - Phone:818-512-5575
Mailing Address - Fax:310-275-0832
Practice Address - Street 1:865 COMSTOCK AVE
Practice Address - Street 2:UNIT 3B
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-2572
Practice Address - Country:US
Practice Address - Phone:818-512-5575
Practice Address - Fax:310-275-0832
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-28
Last Update Date:2012-01-28
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Provider Licenses
StateLicense IDTaxonomies
CAG548882083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine