Provider Demographics
NPI:1518492248
Name:XIE, KIRA (MD)
Entity Type:Individual
Prefix:
First Name:KIRA
Middle Name:
Last Name:XIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1468 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6508
Mailing Address - Country:US
Mailing Address - Phone:201-241-6500
Mailing Address - Fax:
Practice Address - Street 1:10250 SANTA MONICA BLVD STE 1450
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-6495
Practice Address - Country:US
Practice Address - Phone:833-334-6393
Practice Address - Fax:415-345-3430
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA170512207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine