Healthcare Provider Details

I. General information

NPI: 1982904629
Provider Name (Legal Business Name): JOEL VICTOR KLASS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 WASHINGTON ST SUITE #304
HOLLYWOOD FL
33021-8256
US

IV. Provider business mailing address

3760 KENSINGTON ST
HOLLYWOOD FL
33021-1371
US

V. Phone/Fax

Practice location:
  • Phone: 954-961-1500
  • Fax: 954-961-7942
Mailing address:
  • Phone: 954-894-0268
  • Fax: 954-961-7942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number17142
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number17142
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: