Provider Demographics
NPI:1033381124
Name:KLEID, JACK (MD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:KLEID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3660 CLAIREMONT DR
Mailing Address - Street 2:#6
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5909
Mailing Address - Country:US
Mailing Address - Phone:858-274-2560
Mailing Address - Fax:858-274-1610
Practice Address - Street 1:3660 CLAIREMONT DR
Practice Address - Street 2:#6
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5909
Practice Address - Country:US
Practice Address - Phone:858-274-2560
Practice Address - Fax:858-274-1610
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2011-10-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG20415207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG20415BMedicare PIN