Healthcare Provider Details

I. General information

NPI: 1285732388
Provider Name (Legal Business Name): GARY BRADFORD KLEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23861 MCBEAN PKWY SUITE D6
VALENCIA CA
91355-2058
US

IV. Provider business mailing address

23861 MCBEAN PKWY SUITE D6
VALENCIA CA
91355-2058
US

V. Phone/Fax

Practice location:
  • Phone: 661-259-7333
  • Fax: 661-259-6125
Mailing address:
  • Phone: 661-259-7333
  • Fax: 661-259-6125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberC031243
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberC031243
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberC031243
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberC031243
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License NumberC031243
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: