Provider Demographics
NPI:1992022735
Name:LONG, KIRA N (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRA
Middle Name:N
Last Name:LONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1225 CAMPBELL WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-2623
Mailing Address - Country:US
Mailing Address - Phone:360-479-4203
Mailing Address - Fax:360-478-7240
Practice Address - Street 1:1225 CAMPBELL WAY STE 101
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-2623
Practice Address - Country:US
Practice Address - Phone:360-479-4203
Practice Address - Fax:360-478-7240
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.1393582086S0129X
WAMD608443582086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1992022735Medicaid