| Doctor Name: | KEITH WILSON |
| NPI Number: | 1730183344 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | G49347 |
| Business Practice Address: | 1665 Scenic Ave Ste 100 Costa Mesa, CA - 92626 |
| Business Phone Number: | 7144364444 |
| Business Fax Number: | 7144364812 |
| Mailing Address: | 1665 Scenic Ave, Ste 100 COSTA MESA |
| State: | CA |
| Postal Code: | 92626 |
| Phone Number: | 7144364444 |
| Fax Number: | 7144364812 |
| NPI Enumeration Date: | 06/10/2005 |
| NPI Last Update Date: | 09/17/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207V00000X |
| License Number: | G49347 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |