Provider Demographics
NPI:1528700978
Name:KIRSCH, JARED MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:MICHAEL
Last Name:KIRSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S JUANITA AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3693
Mailing Address - Country:US
Mailing Address - Phone:404-610-9036
Mailing Address - Fax:
Practice Address - Street 1:14111 VAN NESS AVE STE 2
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-2944
Practice Address - Country:US
Practice Address - Phone:310-516-9152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA190423208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program