Healthcare Provider Details

I. General information

NPI: 1891750212
Provider Name (Legal Business Name): LEONID KLEYNBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6221 WILSHIRE BLVD SUITE 504
LOS ANGELES CA
90048-5201
US

IV. Provider business mailing address

6221 WILSHIRE BLVD SUITE 504
LOS ANGELES CA
90048-5201
US

V. Phone/Fax

Practice location:
  • Phone: 323-965-9995
  • Fax: 323-965-5678
Mailing address:
  • Phone: 323-965-9995
  • Fax: 323-965-5678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA76900
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: