Provider Demographics
NPI:1013917145
Name:KALLER, STANLEY A (DO)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:A
Last Name:KALLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15111 WHITTIER BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2136
Mailing Address - Country:US
Mailing Address - Phone:562-945-6440
Mailing Address - Fax:562-945-9121
Practice Address - Street 1:15111 WHITTIER BLVD
Practice Address - Street 2:STE 102
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2136
Practice Address - Country:US
Practice Address - Phone:562-945-6440
Practice Address - Fax:562-945-9121
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A3703207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB005OtherCHAMPUS
CA010054114OtherMEDICARE RAIL ROAD PIN
CA00AX37030Medicaid
CA20A3703OtherBCBS
CA020A37030OtherBLUE SHIELD
CAA93561Medicare UPIN
CA010054114OtherMEDICARE RAIL ROAD PIN