MEDICARE: MR. JEFFREY ALAN KLEIN MD

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	207N00000X	Dermatology Physician	G37375	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0070004805	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	00G373750	OTHER	CA	BLUE SHIELD OF CALIFORNIA

General Provider Information

NPI Number	:	1972699304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY ALAN KLEIN MD

Provider Business Mailing Address
First Line	:	30280 RANCHO VIEJOO ROAD
Second Line	:
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675
Country	:	US
Telephone Number	:	949-248-1632
Fax Number	:	949-248-7321

Provider Business Practice Location Address
First Line	:	30280 RANCHO VIEJO RD
Second Line	:
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-1561
Country	:	US
Telephone Number	:	949-248-7641
Fax Number	:	949-248-7321

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	09/20/2024

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