# MARK KLEBANOV MD CORP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700966686
- **Authorized official:** DR. MARK KLEBANOV M.D. (DOCTOR)
- **Authorized official phone:** (925) 296-0344

## Contact information

- **Practice address:** 120 LA CASA VIA STE 102, WALNUT CREEK, CA 94598-3092
- **Practice address phone:** (925) 296-0344
- **Practice address fax:** (925) 947-5424
- **Mailing address:** 120 LA CASA VIA STE 102, WALNUT CREEK, CA 94598-3092
- **Mailing address phone:** (925) 296-0344
- **Mailing address fax:** (925) 947-5424

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | A54480 | CA | Yes |

## Other

- **Enumeration date:** 10/16/2006
- **Last updated:** 08/22/2020