Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC 20273 | CA |
NPI | 1386645067 |
---|---|
Provider Name | Kevin Kuwabara |
First Address | Fullerton, CA 92835-1041 |
Second Address | Fullerton, CA 92835-3813 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U42188 | (02) | CA |