Basic Information
| Provider Information | |||||||||
| NPI: | 1245439728 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROBERT E. KLENCK M.D. INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 13TH ST | ||||||||
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| City: | SEAL BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907406502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189077828 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2001 SANTA MONICA BLVD | ||||||||
| Address2: | 1090 | ||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904042102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105827475 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2007 | ||||||||
| LastUpdateDate: | 07/13/2007 | ||||||||
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| AuthorizedOfficialLastName: | KLENCK | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICAN | ||||||||
| AuthorizedOfficialTelephone: | 8189077828 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | G60894 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.