Provider Demographics
NPI:1609196245
Name:KIRK MEDICAL INCORPORATED
Entity Type:Organization
Organization Name:KIRK MEDICAL INCORPORATED
Other - Org Name:GLENDALE GYNECOLOGY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HOWARTH
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:818-241-6132
Mailing Address - Street 1:1505 WILSON TER
Mailing Address - Street 2:SUITE 220
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4071
Mailing Address - Country:US
Mailing Address - Phone:818-241-6132
Mailing Address - Fax:818-241-6124
Practice Address - Street 1:1505 WILSON TER
Practice Address - Street 2:SUITE 220
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4071
Practice Address - Country:US
Practice Address - Phone:818-241-6132
Practice Address - Fax:818-241-6124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-05
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54807207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty