Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 27005 | CA |
NPI | 1134258973 |
---|---|
Provider Name | Dr. Kevin Michael Keating |
First Address | Sacramento, CA 95825-2165 |
Second Address | Sacramento, CA 95825-2165 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 08/07/2007 |