Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | G43711 | CA |
Y | 2086S0122X | Plastic and Reconstructive Surgery | G43711 | CA |
NPI | 1043227069 |
---|---|
Provider Name | Jerome Robert Klein |
First Address | Palm Beach, FL 33480-3613 |
Second Address | Los Angeles, CA 90095 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 27/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G437110 | MEDICAL PPIN # (01) | CA |
142534 | MEDICAL LICENSE (01) | NY |
43979 | FL STATE (01) | FL |
A61748 | (02) | CA |