Healthcare Provider Details

I. General information

NPI: 1144912510
Provider Name (Legal Business Name): EMILY KLEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6090 REDWOOD BLVD
NOVATO CA
94945-4569
US

IV. Provider business mailing address

6090 REDWOOD BLVD
NOVATO CA
94945-4569
US

V. Phone/Fax

Practice location:
  • Phone: 415-448-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A25447
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: