Provider Demographics
NPI:1538435276
Name:VAN KUIKEN, MICHELLE ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ELIZABETH
Last Name:VAN KUIKEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1420 PEERLESS PL APT 320
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2870
Mailing Address - Country:US
Mailing Address - Phone:281-723-3785
Mailing Address - Fax:
Practice Address - Street 1:200 MEDICAL PLAZA DR SUITE 140
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-3328
Practice Address - Country:US
Practice Address - Phone:310-794-0206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1554912088F0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088F0040XAllopathic & Osteopathic PhysiciansUrologyUrogynecology and Reconstructive Pelvic Surgery