Provider Demographics
NPI:1477665503
Name:KLOMPUS, JOEL M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:M
Last Name:KLOMPUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 WEBSTER ST STE 423
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2380
Mailing Address - Country:US
Mailing Address - Phone:415-923-3179
Mailing Address - Fax:415-563-4687
Practice Address - Street 1:2100 WEBSTER ST STE 423
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2380
Practice Address - Country:US
Practice Address - Phone:415-923-3179
Practice Address - Fax:415-563-4687
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG23532207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG23532OtherSTATE LICENSE NUMBER
CA00A235320Medicare ID - Type UnspecifiedMEDICARE NUMBER
CAG23532OtherSTATE LICENSE NUMBER