Provider Demographics
NPI:1922185768
Name:KENNETH KLEINMAN M.D., INC.
Entity Type:Organization
Organization Name:KENNETH KLEINMAN M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEINMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-300-0081
Mailing Address - Street 1:5525 ETIWANDA AVE STE 312
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-6126
Mailing Address - Country:US
Mailing Address - Phone:818-300-0081
Mailing Address - Fax:818-705-7215
Practice Address - Street 1:5525 ETIWANDA AVE
Practice Address - Street 2:#305
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3647
Practice Address - Country:US
Practice Address - Phone:818-705-7212
Practice Address - Fax:818-705-7215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20401OtherMEDICARE GROUP ID
CAA51788Medicare UPIN
CAWG50719CMedicare PIN