Healthcare Provider Details

I. General information

NPI: 1194786020
Provider Name (Legal Business Name): IRV KLEIN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6815 NOBLE AVE STE.#400
VAN NUYS CA
91405-3796
US

IV. Provider business mailing address

PO BOX 7001
TARZANA CA
91357-7001
US

V. Phone/Fax

Practice location:
  • Phone: 818-901-6690
  • Fax: 818-715-1722
Mailing address:
  • Phone: 818-888-7815
  • Fax: 818-715-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG38255
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG38255
License Number StateCA

VIII. Authorized Official

Name: IRV KLEIN
Title or Position: DIRECT OWNER
Credential: M.D.
Phone: 818-888-7815