Provider Demographics
NPI:1679997209
Name:IRVIN, KATHERINE ANNE (PA)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:ANNE
Last Name:IRVIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 WHITTIER BLVD UNIT 13-18
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-4661
Mailing Address - Country:US
Mailing Address - Phone:323-201-6800
Mailing Address - Fax:
Practice Address - Street 1:6201 WHITTIER BLVD UNIT 13-18
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-4661
Practice Address - Country:US
Practice Address - Phone:323-201-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant