Provider Demographics
NPI:1043216856
Name:KLEIS, JEFFREY (DPM)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:KLEIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 S COAST DR STE 317
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-1528
Mailing Address - Country:US
Mailing Address - Phone:866-333-8710
Mailing Address - Fax:714-434-2665
Practice Address - Street 1:1503 S COAST DR STE 317
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1528
Practice Address - Country:US
Practice Address - Phone:866-333-8710
Practice Address - Fax:714-434-2665
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4240213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T41831Medicare UPIN
CAE4240Medicare ID - Type Unspecified