Provider Demographics
NPI:1982688040
Name:KLEIN, KEITH L (MD,)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:L
Last Name:KLEIN
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 1:8900 WILSHIRE BLVD
Mailing Address - Street 2:350
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1958
Mailing Address - Country:US
Mailing Address - Phone:310-657-9841
Mailing Address - Fax:
Practice Address - Street 1:8900 WILSHIRE BLVD
Practice Address - Street 2:350
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1958
Practice Address - Country:US
Practice Address - Phone:310-657-9841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22950207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D0867505OtherCLIA
CA05D0867505OtherCLIA
CAA41786Medicare UPIN