Provider Demographics
NPI:1619580461
Name:KLEIN, KELLIE JEAN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:JEAN
Last Name:KLEIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:800 FAIRMOUNT AVE STE 323
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3155
Mailing Address - Country:US
Mailing Address - Phone:213-334-4111
Mailing Address - Fax:213-335-5001
Practice Address - Street 1:800 FAIRMOUNT AVE STE 323
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3155
Practice Address - Country:US
Practice Address - Phone:213-334-4111
Practice Address - Fax:213-335-5001
Is Sole Proprietor?:No
Enumeration Date:2020-08-30
Last Update Date:2025-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA64998363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant