Provider Demographics
NPI:1902993843
Name:LEE, KIRSTIN A (MD)
Entity Type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:A
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FILE #54433
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-4433
Mailing Address - Country:US
Mailing Address - Phone:858-784-5888
Mailing Address - Fax:858-642-4270
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1207
Practice Address - Country:US
Practice Address - Phone:858-453-0753
Practice Address - Fax:858-642-4270
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66213207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG66213OtherMED BOARD
CAG66213OtherMED BOARD
F14683Medicare UPIN