Provider Demographics
NPI: | 1659332914 |
---|---|
Name: | KEEFE, JAMES F (MD) |
Entity type: | Individual |
Prefix: | |
First Name: | JAMES |
Middle Name: | F |
Last Name: | KEEFE |
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: | 10468 DES MOINES AVENUE |
Mailing Address - Street 2: | |
Mailing Address - City: | NORTHRIDGE |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 91326 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 818-832-8010 |
Mailing Address - Fax: | 818-832-8016 |
Practice Address - Street 1: | 555 E HARDY ST |
Practice Address - Street 2: | |
Practice Address - City: | INGLEWOOD |
Practice Address - State: | CA |
Practice Address - Zip Code: | 90301-4011 |
Practice Address - Country: | US |
Practice Address - Phone: | 310-680-8391 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-03-28 |
Last Update Date: | 2025-09-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | C36906 | 207ZC0500X, 207ZP0102X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No | 207ZC0500X | Allopathic & Osteopathic Physicians | Pathology | Cytopathology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | 00C369060 | Medicaid | |
CA | WC36906B | Medicare ID - Type Unspecified | PPIN |
CA | F36701 | Medicare UPIN |