=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518492248
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIRA XIE MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2017
-----------------------------------------------------
Last Update Date | 03/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10250 SANTA MONICA BLVD STE 1450
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90067-6495
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-334-6393
-----------------------------------------------------
Fax | 415-345-3430
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1468 MADISON AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10029-6508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-241-6500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | A170512
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------