Provider Demographics
NPI:1114225950
Name:JEFFREY KLEIS, DPM, INC
Entity Type:Organization
Organization Name:JEFFREY KLEIS, DPM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:866-333-8710
Mailing Address - Street 1:1503 S COAST DR STE 317
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-1528
Mailing Address - Country:US
Mailing Address - Phone:866-333-8710
Mailing Address - Fax:714-434-2665
Practice Address - Street 1:1503 S COAST DR STE 317
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1528
Practice Address - Country:US
Practice Address - Phone:866-333-8710
Practice Address - Fax:714-434-2665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4240213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty