Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G17856 | CA |
N | 207PE0004X | Emergency Medical Services | G17856 | CA |
NPI | 1134578776 |
---|---|
Provider Name | Dr. Michael Klass |
First Address | Half Moon Bay, CA 94019-2272 |
Second Address | Half Moon Bay, CA 94019-2272 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2016 |
Last Update Date | 04/06/2016 |