Healthcare Provider Details

I. General information

NPI: 1396941290
Provider Name (Legal Business Name): DERMATOLOGY SURGICAL-MEDICAL CLINICS SANTA CLARITA VALLEY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2007
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 TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberC031243
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology 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 TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberC031243
License Number StateCA

VIII. Authorized Official

Name: DR. GARY BRADFORD KLEIN
Title or Position: OWNER
Credential: M.D
Phone: 661-259-7333