Provider Demographics
NPI:1346372398
Name:KITCHEN, CLYDE K (MD)
Entity Type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:K
Last Name:KITCHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 N HARBOR BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4124
Mailing Address - Country:US
Mailing Address - Phone:714-879-0023
Mailing Address - Fax:714-526-2020
Practice Address - Street 1:1321 N HARBOR BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4124
Practice Address - Country:US
Practice Address - Phone:714-879-0023
Practice Address - Fax:714-526-2020
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC26481207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00665988OtherRAIL ROAD MEDICARE
CAP00665988OtherRAIL ROAD MEDICARE
CAAY013Medicare UPIN
CAW15226Medicare UPIN
CAA41428Medicare PIN