Provider Demographics
NPI:1326245028
Name:KIRSCH, STEPHEN (MCD CCC-A)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:KIRSCH
Suffix:
Gender:M
Credentials:MCD CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 WILSHIRE BLVD
Mailing Address - Street 2:STE 450
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4742
Mailing Address - Country:US
Mailing Address - Phone:310-899-6229
Mailing Address - Fax:310-899-5722
Practice Address - Street 1:2730 WILSHIRE BLVD
Practice Address - Street 2:STE 450
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4742
Practice Address - Country:US
Practice Address - Phone:310-586-5533
Practice Address - Fax:310-564-1720
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2111237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter