Healthcare Provider Details

I. General information

NPI: 1295538437
Provider Name (Legal Business Name): GEORGIA ANNE KIRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 CAMPUS POINT DR # MC7220
LA JOLLA CA
92037-1300
US

IV. Provider business mailing address

444 LAVERNE AVE
MILL VALLEY CA
94941-3435
US

V. Phone/Fax

Practice location:
  • Phone: 858-657-7025
  • Fax:
Mailing address:
  • Phone: 415-847-2882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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: