1780874636 NPI number — EDWARD KLEIN, M.D. AMC

Table of content: (NPI 1780874636)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780874636 NPI number — EDWARD KLEIN, M.D. AMC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDWARD KLEIN, M.D. AMC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780874636
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1141 W REDONDO BEACH BLVD
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
GARDENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90247-3586
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-532-8124
Provider Business Mailing Address Fax Number:
310-532-2210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1141 W REDONDO BEACH BLVD
Provider Second Line Business Practice Location Address:
302
Provider Business Practice Location Address City Name:
GARDENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90247-3586
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-532-8124
Provider Business Practice Location Address Fax Number:
310-532-2210
Provider Enumeration Date:
07/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KLEIN
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
310-532-8124

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  G26436 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G264360 . This is a "MEDI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1346256542 . This is a "INDIVIDUAL NPI NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 290015209 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00G264360 . This is a "BLUE SHIELD OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 198566300 . This is a "DEPT. OF LABOR" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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