Healthcare Provider Details

I. General information

NPI: 1215566112
Provider Name (Legal Business Name): SCOTT ERIC KLEIN MD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 4TH ST
SAN FRANCISCO CA
94143-2351
US

IV. Provider business mailing address

747 52ND ST STE 245
OAKLAND CA
94609-1809
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2008
  • Fax:
Mailing address:
  • Phone: 510-428-3331
  • Fax: 510-601-3979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: