Individual
DR. KEITH SIMON FEDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1200 ROSECRANS AVE, SUITE 208, MANHATTAN BEACH, CA 90266-2462
(310) 416-9700
(310) 416-1120
Mailing address
1200 ROSECRANS AVE, SUITE 208, MANHATTAN BEACH, CA 90266-2462
(310) 416-9700
(310) 416-1120
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G63788
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95-4378266
TAX ID. NUMBER
CA
Enumeration date
01/30/2007
Last updated
10/20/2011
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