Provider Demographics
NPI:1972699304
Name:KLEIN, JEFFREY ALAN (MD)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ALAN
Last Name:KLEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:30280 RANCHO VIEJOO ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675
Mailing Address - Country:US
Mailing Address - Phone:949-248-1632
Mailing Address - Fax:949-248-7321
Practice Address - Street 1:30280 RANCHO VIEJO RD
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1561
Practice Address - Country:US
Practice Address - Phone:949-248-7641
Practice Address - Fax:949-248-7321
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG37375207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0070004805OtherRAILROAD MEDICARE
CA00G373750OtherBLUE SHIELD OF CALIFORNIA
A91888Medicare UPIN
CAWG37375AMedicare ID - Type Unspecified