Healthcare Provider Details

I. General information

NPI: 1962690057
Provider Name (Legal Business Name): KAREN EVE KLEEMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 12TH ST
SANTA MONICA CA
90402-2907
US

IV. Provider business mailing address

531 12TH ST
SANTA MONICA CA
90402-2907
US

V. Phone/Fax

Practice location:
  • Phone: 310-394-4772
  • Fax: 310-458-4112
Mailing address:
  • Phone: 310-394-4772
  • Fax: 310-458-4112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberG44384
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: