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General NPI Number Information
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NPI Number | 1811510043
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Entity Type | Individual
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Provider Name | MICHAEL J KODRICH ELECTROLOGIST
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Gender | Male
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Dates
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Enumeration Date | 05/21/2020
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Last Update Date | 04/01/2022
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Provider Practice Location Address
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Address Line | 15051 GOLDENWEST ST
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-2710
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Country | US
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Telephone | 714-642-4622
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Fax | 714-642-4622
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Provider Business Mailing Address
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Address Line | 6131 MONTECITO DR
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-3222
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Country | US
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Telephone | 714-383-0983
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | L9658
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License Number State | CA
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