Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | G19180 | CA |
NPI | 1033236765 |
---|---|
Provider Name | Calvin Robert Klein |
First Address | Los Angeles, CA 90045-5632 |
Second Address | Santa Monica, CA 90404-2095 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 09/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G19180B | (05) | CA |
A90582 | (02) | CA |