Healthcare Provider Details

I. General information

NPI: 1376748699
Provider Name (Legal Business Name): DAVID H KLINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 WARM SPRINGS AVE STE A
BOISE ID
83712-6457
US

IV. Provider business mailing address

750 WARM SPRINGS AVE STE A
BOISE ID
83712-6457
US

V. Phone/Fax

Practice location:
  • Phone: 208-344-5628
  • Fax: 208-345-2907
Mailing address:
  • Phone: 208-344-5628
  • Fax: 208-345-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberO-0467
License Number StateID

VIII. Authorized Official

Name: JILL MALLOW
Title or Position: OFFICE MANAGER
Credential:
Phone: 208-344-5628