Provider Demographics
NPI:1952515629
Name:KLEIN, DANIEL ETHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ETHAN
Last Name:KLEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1425 WESTERN AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2088
Mailing Address - Country:US
Mailing Address - Phone:206-442-9700
Mailing Address - Fax:206-442-9409
Practice Address - Street 1:1425 WESTERN AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2088
Practice Address - Country:US
Practice Address - Phone:206-442-9700
Practice Address - Fax:206-442-9409
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD000260982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA85192Medicare UPIN