MEDICARE: JENNIFER KLEIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor	22	CA

General Provider Information

NPI Number	:	1407025554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER KLEIN

Provider Business Mailing Address
First Line	:	602 7TH STREET
Second Line	:
City	:	HUNTIGNTON BEACH
State	:	CA
Zip	:	92648-4613
Country	:	US
Telephone Number	:	310-463-5236
Fax Number	:

Provider Business Practice Location Address
First Line	:	602 7TH ST
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-4613
Country	:	US
Telephone Number	:	310-463-5236
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2008
Last Update Date	:	02/22/2008

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