Provider Demographics
NPI:1851943633
Name:KLINE-KOENIG, ZOE ROSE
Entity Type:Individual
Prefix:MISS
First Name:ZOE
Middle Name:ROSE
Last Name:KLINE-KOENIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 ROYAL STEWART DR
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-1600
Mailing Address - Country:US
Mailing Address - Phone:714-269-4259
Mailing Address - Fax:
Practice Address - Street 1:2222 MARTIN STE 170
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1450
Practice Address - Country:US
Practice Address - Phone:949-474-5577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician