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General NPI Number Information
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NPI Number | 1184823205
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Entity Type | Organization
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Legal Business Name | KIRK A CHURUKIAN M D P S C
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Dates
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Enumeration Date | 07/18/2007
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Last Update Date | 11/07/2022
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Provider Practice Location Address
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Address Line | 14830 LOS GATOS BLVD STE 300
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City | LOS GATOS
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State | CA
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Zip | 95032-2053
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Country | US
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Telephone | 408-358-7000
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Fax | 408-358-7005
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Provider Business Mailing Address
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Address Line | 14830 LOS GATOS BLVD STE 300
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City | LOS GATOS
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State | CA
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Zip | 95032-2053
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Country | US
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Telephone | 408-358-7000
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Fax | 408-358-7005
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Authorized Official
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Title or Position | PRESIDENT
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Name | KIRK A CHURUKIAN
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Credential | M D P S C
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Telephone | 408-358-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | G61482
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License Number State | CA
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