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General NPI Number Information
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NPI Number | 1528646742
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Entity Type | Organization
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Legal Business Name | SAMUEL D VAN KIRK MD, INC
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Dates
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Enumeration Date | 03/30/2021
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Last Update Date | 03/30/2021
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Provider Practice Location Address
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Address Line | 2139 AIRPARK DR
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City | REDDING
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State | CA
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Zip | 96001-2433
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Country | US
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Telephone | 530-247-0270
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Fax | 530-247-0271
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Provider Business Mailing Address
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Address Line | 2139 AIRPARK DR
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City | REDDING
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State | CA
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Zip | 96001-2433
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Country | US
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Telephone | 530-247-0270
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Fax | 530-247-0271
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Authorized Official
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Title or Position | OWNER
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Name | SAMUEL D VAN KIRK
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Credential | MD
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Telephone | 530-247-0270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number |
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License Number State |
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