Provider Demographics
NPI:1346616760
Name:MURCH, KAITLYN NGUYEN (OD)
Entity Type:Individual
Prefix:DR
First Name:KAITLYN
Middle Name:NGUYEN
Last Name:MURCH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:NHUY
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1290 HAMNER AVE
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-3117
Mailing Address - Country:US
Mailing Address - Phone:951-268-3037
Mailing Address - Fax:951-735-2869
Practice Address - Street 1:1290 HAMNER AVE
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-3117
Practice Address - Country:US
Practice Address - Phone:951-268-3037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15395TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1346616760Medicaid