Healthcare Provider Details

I. General information

NPI: 1871620492
Provider Name (Legal Business Name): KIMBERLY S KLAUSNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 04/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 N ROXBURY DRIVE SUITE 311
BEVERLY HILLS CA
90210
US

IV. Provider business mailing address

435 N ROXBURY DRIVE SUITE 311
BEVERLY HILLS CA
90210
US

V. Phone/Fax

Practice location:
  • Phone: 310-657-4586
  • Fax: 310-657-0986
Mailing address:
  • Phone: 310-657-4586
  • Fax: 310-657-0986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA54665
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: