MEDICARE: KIYANAZAKIYA BUIE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246RP1900X	Phlebotomy Technician	C9N4N6Q3	CA

General Provider Information

NPI Number	:	1750249439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIYANAZAKIYA BUIE

Provider Business Mailing Address
First Line	:	1212 W GARDENA BLVD STE C1
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90247-4896
Country	:	US
Telephone Number	:	877-806-1016
Fax Number	:

Provider Business Practice Location Address
First Line	:	1212 W GARDENA BLVD STE C1
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90247-4896
Country	:	US
Telephone Number	:	877-806-1016
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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Directions to “ KIYANAZAKIYA BUIE ” Practice Location

Language	Start Address	Practice Location

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