Provider Demographics
NPI:1841375474
Name:KIRBY, WILLIAM (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:KIRBY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 HERMOSA AVE
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-3532
Mailing Address - Country:US
Mailing Address - Phone:888-631-7773
Mailing Address - Fax:310-861-8221
Practice Address - Street 1:1312 HERMOSA AVE
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-3532
Practice Address - Country:US
Practice Address - Phone:888-631-7773
Practice Address - Fax:310-861-8221
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8225207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology