Healthcare Provider Details

I. General information

NPI: 1578645586
Provider Name (Legal Business Name): SUZANNE W KLEIN MD MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10510 GRAVELLY LAKE DR SW LAKEWOOD CLINIC
TACOMA WA
98499-5036
US

IV. Provider business mailing address

1019 PACIFIC AVENUE #300 COMMUNITY HEALTH CARE
TACOMA WA
98402
US

V. Phone/Fax

Practice location:
  • Phone: 253-589-7030
  • Fax: 253-589-7033
Mailing address:
  • Phone: 253-722-1540
  • Fax: 253-722-1546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number116111
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number60205336
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: