Organization
WENSLEY M KEITH MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMY KNICKERBOCKER (MANAGER)
(949) 610-5240
Entity
Organization
Contact information
Practice address
1601 DOVE ST STE 170, NEWPORT BEACH, CA 92660-1421
(949) 610-5240
Mailing address
1601 DOVE ST STE 170, NEWPORT BEACH, CA 92660-1421
(949) 610-5240
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
08/27/2024
Last updated
05/28/2025
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