Provider Demographics
NPI:1205826237
Name:KLEIN, MICHAEL VINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:VINCENT
Last Name:KLEIN
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 1:4275 EXECUTIVE SQ
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-9123
Mailing Address - Country:US
Mailing Address - Phone:858-999-8599
Mailing Address - Fax:858-999-8599
Practice Address - Street 1:4275 EXECUTIVE SQ
Practice Address - Street 2:SUITE 200
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-9123
Practice Address - Country:US
Practice Address - Phone:858-999-8599
Practice Address - Fax:858-999-8599
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG752342085B0100X, 2085N0904X, 2085R0204X, 2085U0001X, 2085R0202X
ARE-61042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G752340Medicaid
CAP00033516OtherRAILROAD MEDICARE
CABG327ZMedicare PIN
CAWG75234Medicare ID - Type Unspecified
CAF81919Medicare UPIN
CA00G752340Medicaid