Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | G60421 | CA |
NPI | 1053417626 |
---|---|
Provider Name | Lindon Ken Kawahara |
First Address | Torrance, CA 90505-2539 |
Second Address | Torrance, CA 90505-2539 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 23/08/2010 |