Michael J Kodrich, ELECTROLOGIST

Primary specialty

SpecialistTaxonomy code 174400000X

License

L9658 Issued in CA

Practice address

15051 Goldenwest St
Huntington Beach, CA 92647-2710

Phone

(714) 642-4622

Fax

(714) 642-4622

NPI assigned

May 21, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1590019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648771200000",
    "number": "1811510043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6131 MONTECITO DR",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926473222",
            "telephone_number": "714-383-0983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15051 GOLDENWEST ST",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926472710",
            "telephone_number": "714-642-4622",
            "fax_number": "714-642-4622"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "40555 California Oaks Rd",
            "address_purpose": "LOCATION",
            "city": "Murrieta",
            "state": "CA",
            "postal_code": "925625723",
            "country_code": "US",
            "telephone_number": "951-433-0954",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KODRICH",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "ELECTROLOGIST",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-05-21",
        "last_updated": "2022-04-01",
        "certification_date": "2022-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "L9658",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wesley Masura Kobayashi, DPM
• Ashley Kobeszko
• Lesley Anne Koch, PT
• Kathleen Kochalko, DPT
• Thomas Christopher Kockinis, MD
• Craig Curtis Koehler, DC
• Alexis Nicole Koenig, PA
• Luke Koga
• Naoto Kojima
• Glenn Tetsuo Komae, D.D.S.

• Specialist in Huntington Beach, CA
• Providers in Huntington Beach, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.