Provider Demographics
NPI:1902288079
Name:SAMUELS, KIRK (DDS)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:
Last Name:SAMUELS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20810 ANZA AVE
Mailing Address - Street 2:#1-314
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4225
Mailing Address - Country:US
Mailing Address - Phone:347-404-4613
Mailing Address - Fax:
Practice Address - Street 1:1000 WEST CARSON STREET BOX 19
Practice Address - Street 2:HARBOR-UCLA MEDICAL CENTER
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90509-4225
Practice Address - Country:US
Practice Address - Phone:424-338-2401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program