Provider Demographics
NPI:1285732388
Name:KLEIN, GARY BRADFORD (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:BRADFORD
Last Name:KLEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23861 MCBEAN PKWY
Mailing Address - Street 2:SUITE D6
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-2058
Mailing Address - Country:US
Mailing Address - Phone:661-259-7333
Mailing Address - Fax:661-259-6125
Practice Address - Street 1:23861 MCBEAN PKWY
Practice Address - Street 2:SUITE D6
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-2058
Practice Address - Country:US
Practice Address - Phone:661-259-7333
Practice Address - Fax:661-259-6125
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC031243207N00000X, 207ND0900X, 207NP0225X, 207NS0135X, 207NI0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC031243OtherSTATE LICENSE
CA953527990OtherTAX ID
CA953527990OtherTAX ID
CAAK0041652OtherDEA CERTIFICATE #
CAC031243OtherSTATE LICENSE