Provider Demographics
NPI:1811923568
Name:KLUG, DONALD ERWIN (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ERWIN
Last Name:KLUG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:151 N SUNRISE AVE
Mailing Address - Street 2:SUITE 1201
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2924
Mailing Address - Country:US
Mailing Address - Phone:916-789-2011
Mailing Address - Fax:916-789-2014
Practice Address - Street 1:151 N SUNRISE AVE
Practice Address - Street 2:SUITE 1201
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2924
Practice Address - Country:US
Practice Address - Phone:916-789-2011
Practice Address - Fax:916-789-2014
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG26922207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G269220Medicaid
CAA43148Medicare UPIN
CA00G269220Medicaid