Healthcare Provider Details

I. General information

NPI: 1538435276
Provider Name (Legal Business Name): MICHELLE ELIZABETH VAN KUIKEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 12/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PLAZA DR SUITE 140
LOS ANGELES CA
90095-3328
US

IV. Provider business mailing address

1420 PEERLESS PL APT 320
LOS ANGELES CA
90035-2870
US

V. Phone/Fax

Practice location:
  • Phone: 310-794-0206
  • Fax:
Mailing address:
  • Phone: 281-723-3785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License NumberA155491
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: