Provider Demographics
NPI:1740381219
Name:KLEIN, PETER A (PH D)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:A
Last Name:KLEIN
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 BURGESS DRIVE
Mailing Address - Street 2:#150
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025
Mailing Address - Country:US
Mailing Address - Phone:650-599-2701
Mailing Address - Fax:650-327-0738
Practice Address - Street 1:445 BURGESS DRIVE
Practice Address - Street 2:#150
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025
Practice Address - Country:US
Practice Address - Phone:650-599-2701
Practice Address - Fax:650-327-0738
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12966103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL129660Medicare ID - Type Unspecified
P15001Medicare UPIN