Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY9105 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY9105 | CA |
NPI | 1003039876 |
---|---|
Provider Name | Dr. Dennis S. Klos |
First Address | Los Angeles, CA 90025-3377 |
Second Address | Los Angeles, CA 90025-3377 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 08/07/2007 |