Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | A55621 | CA |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | A55621 | CA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | A55621 | CA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A55621 | CA |
N | 207XX0801X | Orthopaedic Trauma Surgeon | A55621 | CA |
NPI | 1245285394 |
---|---|
Provider Name | Alan T Kawaguchi |
First Address | Stockton, CA 95204-5508 |
Second Address | Stockton, CA 95204-5508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 10/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0368640001 | DMERC (01) | |
CGP159090 | CGP# (01) | |
G95320 | (02) | |
ZZZ71793Z | (05) | CA |