Healthcare Provider Details

I. General information

NPI: 1194071167
Provider Name (Legal Business Name): TIFFANY ARTHUR KLEIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. TIFFANY A. KLEIN WIGHTMAN

II. Dates (important events)

Enumeration Date: 07/27/2012
Last Update Date: 07/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3641 SACRAMENTO ST SUITE A
SAN FRANCISCO CA
94118-1722
US

IV. Provider business mailing address

322 SONORA DR
SAN MATEO CA
94402-2340
US

V. Phone/Fax

Practice location:
  • Phone: 415-601-1339
  • Fax: 415-931-6523
Mailing address:
  • Phone: 650-931-4934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA108717
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: