Provider Demographics
NPI:1346826187
Name:BIRD, MACKENZIE LYNN (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:MACKENZIE
Middle Name:LYNN
Last Name:BIRD
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 BEECHTREE DR
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-1202
Mailing Address - Country:US
Mailing Address - Phone:914-420-0291
Mailing Address - Fax:
Practice Address - Street 1:444 S SAN VICENTE BLVD STE 603
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4178
Practice Address - Country:US
Practice Address - Phone:310-423-1282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program