Provider Demographics
NPI:1568678662
Name:ROBERT BRAHM KLEIN, MD
Entity Type:Organization
Organization Name:ROBERT BRAHM KLEIN, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BRAHM
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-885-9400
Mailing Address - Street 1:18350 ROSCOE BLVD
Mailing Address - Street 2:SUITE 701
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4109
Mailing Address - Country:US
Mailing Address - Phone:818-885-9400
Mailing Address - Fax:818-885-9403
Practice Address - Street 1:18350 ROSCOE BLVD
Practice Address - Street 2:SUITE 701
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4109
Practice Address - Country:US
Practice Address - Phone:818-885-9400
Practice Address - Fax:818-885-9403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75013208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A750130Medicaid
CAA75013OtherBLUE SHIELD PROVIDER NUMB
CA00A750130Medicaid