Healthcare Provider Details

I. General information

NPI: 1841266046
Provider Name (Legal Business Name): ANDRIUS KIRSONIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 W OLYMPIC BLVD
LOS ANGELES CA
90015-1329
US

IV. Provider business mailing address

6420 VIA ESCONDIDO DR
MALIBU CA
90265-4417
US

V. Phone/Fax

Practice location:
  • Phone: 310-383-5173
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberG43231
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: