# KEITH L AGRE, MD, MEDICAL CORPORATION

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760664411
- **Authorized official:** KEITH L AGRE M.D. (PRESIDENT)
- **Authorized official phone:** (310) 276-2033

## Contact information

- **Practice address:** 1125 S BEVERLY DR, SUITE 110, LOS ANGELES, CA 90035-1148
- **Practice address phone:** (310) 276-2033
- **Practice address fax:** (310) 858-3857
- **Mailing address:** 1125 S BEVERLY DR, SUITE 110, LOS ANGELES, CA 90035-1148
- **Mailing address phone:** (310) 276-2033
- **Mailing address fax:** (310) 858-3857

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | C24838 | CA | Yes |

## Other

- **Enumeration date:** 12/04/2007
- **Last updated:** 12/04/2007