Individual
KEIVAN EDALAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1145 WEST REDONDO BEACH BLVD, GARDENA, CA 90247
(310) 538-6629
Mailing address
PO BOX 11260, WESTMINSTER, CA 92685-1260
(562) 809-3542
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
A67803
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A678030
—
CA
Enumeration date
06/12/2006
Last updated
05/22/2008
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