Healthcare Provider Details

I. General information

NPI: 1508095183
Provider Name (Legal Business Name): JENNIFER MARLETTE KLOS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2009
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 WESTOWN PKWY STE 100
WEST DES MOINES IA
50266-1314
US

IV. Provider business mailing address

4737 COUNTY ROAD 101 # 203
MINNETONKA MN
55345-2634
US

V. Phone/Fax

Practice location:
  • Phone: 510-925-2003
  • Fax:
Mailing address:
  • Phone: 510-925-2003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number56190
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number5101018349
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: