Healthcare Provider Details

I. General information

NPI: 1528700978
Provider Name (Legal Business Name): JARED MICHAEL KIRSCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14111 VAN NESS AVE STE 2
GARDENA CA
90249-2944
US

IV. Provider business mailing address

225 S JUANITA AVE UNIT A
REDONDO BEACH CA
90277-3693
US

V. Phone/Fax

Practice location:
  • Phone: 310-516-9152
  • Fax:
Mailing address:
  • Phone: 404-610-9036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA190423
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: