Provider Demographics
NPI:1659561744
Name:LEIZEROVITZ, KIRA
Entity Type:Individual
Prefix:MISS
First Name:KIRA
Middle Name:
Last Name:LEIZEROVITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 N FULLER AVE APT 303
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-4245
Mailing Address - Country:US
Mailing Address - Phone:323-356-8900
Mailing Address - Fax:
Practice Address - Street 1:1420 N FULLER AVE APT 303
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-4245
Practice Address - Country:US
Practice Address - Phone:323-356-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDHAP136124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist