Provider Demographics
NPI:1467436568
Name:KLEIN, RUSSELL A (MD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:A
Last Name:KLEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16101 VENTURA BLVD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2500
Mailing Address - Country:US
Mailing Address - Phone:818-788-7500
Mailing Address - Fax:818-380-9245
Practice Address - Street 1:16101 VENTURA BLVD
Practice Address - Street 2:SUITE 340
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2500
Practice Address - Country:US
Practice Address - Phone:818-788-7500
Practice Address - Fax:818-380-9245
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2012-06-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG22898207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41762Medicare UPIN