MEDICARE: STANLEY A KALLER DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	20A3703	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	010054114	OTHER	CA	MEDICARE RAIL ROAD PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B005	OTHER	CA	CHAMPUS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	20A3703	OTHER	CA	BCBS
5	020A37030	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1013917145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STANLEY A KALLER DO

Provider Business Mailing Address
First Line	:	15111 WHITTIER BLVD
Second Line	:	STE 102
City	:	WHITTIER
State	:	CA
Zip	:	90603-2136
Country	:	US
Telephone Number	:	562-945-6440
Fax Number	:	562-945-9121

Provider Business Practice Location Address
First Line	:	15111 WHITTIER BLVD
Second Line	:	STE 102
City	:	WHITTIER
State	:	CA
Zip	:	90603-2136
Country	:	US
Telephone Number	:	562-945-6440
Fax Number	:	562-945-9121

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	12/30/2009

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Directions to “ STANLEY A KALLER DO” Practice Location

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