Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E4240 | CA |
Y | 222Z00000X | Podiatrist | E4240 | CA |
NPI | 1043216856 |
---|---|
Provider Name | Dr. Jeffrey Kleis |
First Address | Costa Mesa, CA 92626-1528 |
Second Address | Costa Mesa, CA 92626-1528 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2005 |
Last Update Date | 01/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T41831 | (02) |