Keerthi R de Silva, M.D., Inc.

Primary specialty

SpecialistTaxonomy code 174400000X

License

A30035 Issued in CA

Legal business name

KEERTHI R DE SILVA, M.D., INC.

Practice address

1141 W Redondo Beach Blvd
Suite 107
Gardena, CA 90247-3586

Phone

(310) 515-0677

Fax

(310) 515-5033

NPI assigned

Jan 31, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Keerthi R Desilva, M.D.

Title

President

Phone

(310) 515-0677

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1201737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206662400000",
    "number": "1356529440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1141 W REDONDO BEACH BLVD",
            "address_2": "SUITE 107",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902473586",
            "telephone_number": "310-515-0677",
            "fax_number": "310-515-5033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1141 W REDONDO BEACH BLVD",
            "address_2": "SUITE 107",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902473586",
            "telephone_number": "310-515-0677",
            "fax_number": "310-515-5033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEERTHI R DE SILVA, M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-31",
        "last_updated": "2008-03-28",
        "status": "A",
        "authorized_official_last_name": "DESILVA",
        "authorized_official_first_name": "KEERTHI",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-515-0677",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A30035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A300350",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.