Provider Demographics
NPI:1346261039
Name:KLASS, ALLAN H (M D)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:H
Last Name:KLASS
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16133 VENTURA BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2429
Mailing Address - Country:US
Mailing Address - Phone:818-986-1357
Mailing Address - Fax:818-986-3282
Practice Address - Street 1:16133 VENTURA BLVD STE 400
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2429
Practice Address - Country:US
Practice Address - Phone:818-986-1357
Practice Address - Fax:818-986-3282
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG12168207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG12168Medicare ID - Type UnspecifiedMEDICARE
CAA38571Medicare UPIN