Provider Demographics
NPI:1093722829
Name:KLEMEK, JOSEPH STANLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:STANLEY
Last Name:KLEMEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1125E 17TH ST E218
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-2218
Mailing Address - Country:US
Mailing Address - Phone:714-835-3031
Mailing Address - Fax:714-835-6546
Practice Address - Street 1:1125E 17TH ST E218
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2218
Practice Address - Country:US
Practice Address - Phone:714-835-3031
Practice Address - Fax:714-835-6546
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29543207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG29543OtherSTATE LICENSE
CAG29543OtherSTATE LICENSE
CA0403290001Medicare NSC
CAG29543Medicare ID - Type Unspecified