Provider Demographics
NPI:1275749319
Name:KLEIN, ILENE J (MD)
Entity Type:Individual
Prefix:DR
First Name:ILENE
Middle Name:J
Last Name:KLEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:13035 CAMINITO DEL ROCIO
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3605
Mailing Address - Country:US
Mailing Address - Phone:858-259-1033
Mailing Address - Fax:858-259-1033
Practice Address - Street 1:5535 MOREHOUSE DR STE S-274
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1710
Practice Address - Country:US
Practice Address - Phone:858-651-5918
Practice Address - Fax:858-651-5953
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC52533207Q00000X
MA207655207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H38861Medicare UPIN