Provider Demographics
NPI:1700031119
Name:LEE, KIRBY BRYAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIRBY
Middle Name:BRYAN
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3875 WILSHIRE BLVD STE 404
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3209
Mailing Address - Country:US
Mailing Address - Phone:213-388-7161
Mailing Address - Fax:
Practice Address - Street 1:3875 WILSHIRE BLVD STE 404
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3209
Practice Address - Country:US
Practice Address - Phone:213-388-7161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice