Individual
BOB KEOPHAKDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDMT
Contact information
Practice address
204 W HILL BLVD, CHARLESTON, SC 29404-4704
(843) 963-6880
Mailing address
PSC 62 BOX 7002, APO, AE 09643-0071
(314) 722-8069
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
09/09/2021
Last updated
12/03/2025
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