Edalat, Keivan
Edalat, Keivan is an individual health care provider with primary practice located at 1145 West Redondo Beach Blvd , Gardena CA 90247. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Edalat, Keivan can be contacted via phone (310) 538-6629.Contact Information
Primary practice address
1145 West Redondo Beach Blvd
Gardena CA 90247
Phone: (310) 538-6629
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Emergency Medicine | 207P00000X | A67803 | California |
Profile Details
| NPI number | 1790727162 |
|---|---|
| LBN Legal business name | Edalat, Keivan |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 12th, 2006 |
| Last updated | May 22nd, 2008 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1790727162 | NPPES |
| California | MEDICAID | 00A678030 |
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