Individual
DR. BOUNMANY KYLE KEOJAMPA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4640 ADMIRALTY WAY, SUITE 718, MARINA DEL REY, CA 90292-6621
(310) 823-4444
(888) 857-4458
Mailing address
4640 ADMIRALTY WAY, SUITE 718, MARINA DEL REY, CA 90292-6621
(310) 823-4444
(888) 857-4458
Taxonomy
Speciality
Code
Description
License number
State
207YS0123X
Facial Plastic Surgery Physician
Primary
134756
CA
207YS0123X
Facial Plastic Surgery Physician
242360
MA
Other
Enumeration date
04/23/2008
Last updated
07/02/2015
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