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General NPI Number Information
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NPI Number | 1902134588
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Entity Type | Organization
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Legal Business Name | MINX MED
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Dates
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Enumeration Date | 11/19/2009
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Last Update Date | 11/19/2009
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Provider Practice Location Address
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Address Line | 10523 BURBANK BLVD 213
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City | N HOLLYWOOD
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State | CA
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Zip | 91601-2233
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Country | US
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Telephone | 818-509-9143
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Fax | 818-509-9367
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Provider Business Mailing Address
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Address Line | 10523 BURBANK BLVD 213
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City | N HOLLYWOOD
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State | CA
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Zip | 91601-2233
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Country | US
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Telephone | 818-509-9143
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Fax | 818-509-9367
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | DR. MICHAEL V KLEIN
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Credential | M D
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Telephone | 818-381-0401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | C75234
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License Number State | CA
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