Provider Demographics
NPI:1508852799
Name:KLEIN, LORRIE J (MD)
Entity Type:Individual
Prefix:
First Name:LORRIE
Middle Name:J
Last Name:KLEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30201 GOLDEN LANTERN STE B
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-5979
Mailing Address - Country:US
Mailing Address - Phone:949-363-1788
Mailing Address - Fax:949-363-1607
Practice Address - Street 1:30201 GOLDEN LANTERN STE B
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-5979
Practice Address - Country:US
Practice Address - Phone:949-363-1788
Practice Address - Fax:949-363-1607
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58945207NS0135X, 207ND0900X, 207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE33326Medicare UPIN
CAWG58945AMedicare PIN