Provider Demographics
NPI:1588823587
Name:DAVID G. KLEINBRODT, DPM, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DAVID G. KLEINBRODT, DPM, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GADI
Authorized Official - Last Name:KLEINBRODT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:818-657-9411
Mailing Address - Street 1:21900 MARYLEE ST UNIT 285
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-4826
Mailing Address - Country:US
Mailing Address - Phone:818-657-9411
Mailing Address - Fax:
Practice Address - Street 1:22110 ROSCOE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304-3861
Practice Address - Country:US
Practice Address - Phone:818-657-9411
Practice Address - Fax:818-716-1530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4662261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty