Provider Demographics
NPI:1679653869
Name:KIRSCH, HENRY LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:LOUIS
Last Name:KIRSCH
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 1:9808 VENICE BLVD
Mailing Address - Street 2:SUITE 503
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2732
Mailing Address - Country:US
Mailing Address - Phone:310-287-3111
Mailing Address - Fax:310-287-3132
Practice Address - Street 1:9808 VENICE BLVD
Practice Address - Street 2:SUITE 503
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2732
Practice Address - Country:US
Practice Address - Phone:310-287-3111
Practice Address - Fax:310-287-3132
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36527174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA36527OtherLICENSE
CA00A36527OMedicaid
CA00A36527OMedicaid
CAA36527OtherLICENSE