Provider Demographics
NPI:1316179187
Name:DOTY, BRIAN KIRK (DD LAC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:KIRK
Last Name:DOTY
Suffix:
Gender:M
Credentials:DD LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 E ROUTE 66 STE 106
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-3769
Mailing Address - Country:US
Mailing Address - Phone:626-382-9715
Mailing Address - Fax:626-963-0180
Practice Address - Street 1:1135 E ROUTE 66 STE 106
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-3769
Practice Address - Country:US
Practice Address - Phone:626-382-9715
Practice Address - Fax:626-963-0180
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 9049171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist