Provider Demographics
NPI:1760476386
Name:KLEYN, RONALD (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:KLEYN
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 28949
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-8949
Mailing Address - Country:US
Mailing Address - Phone:559-228-4200
Mailing Address - Fax:559-224-3920
Practice Address - Street 1:6331 N FRESNO ST STE 104
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5283
Practice Address - Country:US
Practice Address - Phone:559-437-2700
Practice Address - Fax:559-437-2712
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42548207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A425481Medicare PIN
CA00A425488Medicare PIN
CA080104392Medicare PIN
CAA29603Medicare UPIN
CA00A425484Medicare PIN
CA00A4254810Medicare PIN
CA00A425487Medicare PIN
CA00A425482Medicare PIN
CA00A425485Medicare PIN
CA00A425486Medicare PIN
CA00A425480Medicare PIN
CA00A425483Medicare PIN
CA00425489Medicare PIN