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General NPI Number Information
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NPI Number | 1164473351
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Entity Type | Individual
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Provider Name | LEE KISSEL MD
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Gender | Male
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Dates
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Enumeration Date | 05/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 855 MANHATTAN BEACH BLVD SUITE 102
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-4965
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Country | US
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Telephone | 310-939-7858
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Fax | 310-939-7842
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Provider Business Mailing Address
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Address Line | 3105 LOMITA BLVD
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City | TORRANCE
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State | CA
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Zip | 90505-5108
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Country | US
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Telephone | 310-784-4926
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Fax | 310-891-6793
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G45642
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License Number State | CA
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