Provider Demographics
NPI:1700103298
Name:KLEYNBERG, ROMAN LEONID (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMAN
Middle Name:LEONID
Last Name:KLEYNBERG
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 1:6221 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 504
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5201
Mailing Address - Country:US
Mailing Address - Phone:323-965-5679
Mailing Address - Fax:323-965-5678
Practice Address - Street 1:6221 WILSHIRE BLVD
Practice Address - Street 2:SUITE 504
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5201
Practice Address - Country:US
Practice Address - Phone:323-965-5679
Practice Address - Fax:323-965-5678
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA120343207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA120343Medicare PIN