Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 050623 | CT |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 50623 | CT |
N | 2086X0206X | Surgical Oncologist | 050623 | CT |
NPI | 1255524328 |
---|---|
Provider Name | Dr. Clinton Akira Kuwada |
First Address | Wethersfield, CT 06109 |
Second Address | Hartford, CT 06106-5522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2007 |
Last Update Date | 27/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
008041202 | (05) | CT |