Provider Demographics
NPI:1245220649
Name:EIRICH, GREGORY KIRK (DPM, FACFAS)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:KIRK
Last Name:EIRICH
Suffix:
Gender:M
Credentials:DPM, FACFAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13362 NEWPORT AVE STE A
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3427
Mailing Address - Country:US
Mailing Address - Phone:714-669-1780
Mailing Address - Fax:714-669-1488
Practice Address - Street 1:13362 NEWPORT AVE STE A
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3427
Practice Address - Country:US
Practice Address - Phone:714-669-1780
Practice Address - Fax:714-669-1488
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3763213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E37630Medicaid
CA1245220649Medicaid
U17683Medicare UPIN
CAE3763Medicare PIN