Provider Demographics
NPI:1669174439
Name:KLEIN, LUCIEN (CMT)
Entity type:Individual
Prefix:
First Name:LUCIEN
Middle Name:
Last Name:KLEIN
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3714 KELLER AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-3053
Mailing Address - Country:US
Mailing Address - Phone:618-319-2398
Mailing Address - Fax:
Practice Address - Street 1:4400 KELLER AVE STE 250
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-4232
Practice Address - Country:US
Practice Address - Phone:510-982-1875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92026225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist