Provider Demographics
NPI:1023208683
Name:HAWTHORNE, KINJI LOTHARIO (MD)
Entity Type:Individual
Prefix:
First Name:KINJI
Middle Name:LOTHARIO
Last Name:HAWTHORNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:47647 CALEO BAY DR STE 210
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-8858
Mailing Address - Country:US
Mailing Address - Phone:760-771-1000
Mailing Address - Fax:760-771-9001
Practice Address - Street 1:47647 CALEO BAY DR STE 210
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-8858
Practice Address - Country:US
Practice Address - Phone:760-771-1000
Practice Address - Fax:760-771-9001
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA68919207RI0200X
CAA64097207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease