Provider Demographics
NPI:1720017338
Name:KLINE, MICHAEL M (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:M
Last Name:KLINE
Suffix:
Gender:M
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:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-5100
Mailing Address - Fax:
Practice Address - Street 1:1520 SAN PABLO ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5310
Practice Address - Country:US
Practice Address - Phone:323-442-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG19796207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA100011692OtherRAILROAD MEDICARE
CAW18762OtherGROUP MEDICARE
CAGR0016910OtherGROUP MEDICAID PIN
CAGR0100430OtherGROUP MEDICAL
CA00G197960OtherBLUE SHIELD
CA1902846306OtherGROUP NPI
CAGR0016910OtherGROUP MEDICARE PIN
CACE1617OtherGROUP RAILROAD MEDICARE
CA00G197960Medicaid
CA1356390009OtherGROUP NPI
CACE1617OtherGROUP RAILROAD MEDICARE
CAW18762OtherGROUP MEDICARE