Provider Demographics
NPI:1477818235
Name:KIRK, MICHELLE NGUYEN (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:NGUYEN
Last Name:KIRK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10088 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-4905
Mailing Address - Country:US
Mailing Address - Phone:714-962-9377
Mailing Address - Fax:
Practice Address - Street 1:10088 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-4905
Practice Address - Country:US
Practice Address - Phone:714-962-9377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 14393 TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist