MEDICARE: PROF. KIRSTEN HOPE FICK P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA18599	CA

General Provider Information

NPI Number	:	1184828659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. KIRSTEN HOPE FICK P.A.

Provider Business Mailing Address
First Line	:	6 MOJO CT
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-2334
Country	:	US
Telephone Number	:	949-631-1867
Fax Number	:

Provider Business Practice Location Address
First Line	:	12556 VALLEY VIEW ST
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845-2006
Country	:	US
Telephone Number	:	714-897-9355
Fax Number	:	714-897-5117

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2007
Last Update Date	:	03/07/2023

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