Provider Demographics
NPI:1306882949
Name:KLONOFF, DAVID C (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:KLONOFF
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1720 EL CAMINO REAL
Mailing Address - Street 2:SUITE #130
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3224
Mailing Address - Country:US
Mailing Address - Phone:650-697-4345
Mailing Address - Fax:650-259-5840
Practice Address - Street 1:1720 EL CAMINO REAL
Practice Address - Street 2:SUITE #130
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3224
Practice Address - Country:US
Practice Address - Phone:650-697-4345
Practice Address - Fax:650-259-5840
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG35726207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G357260Medicaid
CAA46454Medicare UPIN
CA00G357260Medicare PIN