Active NPI
Suzanne W Klein, MD MPH
- Pediatrics Physician
- Tacoma, WA
National Provider Identifier
1578645586
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 60205336
- Practice address
- 10510 Gravelly Lake Dr SW
Lakewood Clinic
Tacoma, WA 98499-5036 - Phone
- (253) 589-7030
- Fax
- (253) 589-7033
- NPI assigned
- Oct 19, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 116111 | NY | |
| Pediatrics Physician | 208000000X | 60205336 | WA | Primary |
Addresses
Primary practice location
10510 Gravelly Lake Dr SW
Lakewood Clinic
Tacoma, WA 98499-5036
Mailing address
1019 Pacific Avenue #300
Community Health Care
Tacoma, WA 98402
Phone (253) 722-1540
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00459563 | Medicaid | NY | |
| 100660DL | Other | NY | PREFERRED CARE |
| 7744066 | Other | NY | AETNA |
| P010116111 | Other | NY | EXCELLUS BC/BS ROCHESTER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60205336 | WA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366761600000",
"number": "1578645586",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1019 PACIFIC AVENUE #300",
"address_2": "COMMUNITY HEALTH CARE",
"city": "TACOMA",
"state": "WA",
"postal_code": "98402",
"telephone_number": "253-722-1540",
"fax_number": "253-722-1546"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10510 GRAVELLY LAKE DR SW",
"address_2": "LAKEWOOD CLINIC",
"city": "TACOMA",
"state": "WA",
"postal_code": "984995036",
"telephone_number": "253-589-7030",
"fax_number": "253-589-7033"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLEIN",
"first_name": "SUZANNE",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "MD MPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-19",
"last_updated": "2013-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "116111",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "WA",
"license": "60205336",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00459563",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED CARE",
"identifier": "100660DL",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7744066",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EXCELLUS BC/BS ROCHESTER",
"identifier": "P010116111",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.