Provider Demographics
NPI:1710938808
Name:LUECK, KRISTIN L (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:L
Last Name:LUECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:KRISTIN
Other - Middle Name:LUECK
Other - Last Name:KAVIRAJAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6650 ALTON PKWY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3734
Mailing Address - Country:US
Mailing Address - Phone:888-988-2800
Mailing Address - Fax:
Practice Address - Street 1:6650 ALTON PKWY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3734
Practice Address - Country:US
Practice Address - Phone:888-988-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA786512084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A786510OtherMEDI-CAL PROVIDER #
CA00A786510OtherMEDI-CAL PROVIDER #
CAWA78651AMedicare ID - Type UnspecifiedMEDICARE PROVIDER #