Provider Demographics
NPI:1083722003
Name:KAHWAJI, MICHEL NOFAL (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHEL
Middle Name:NOFAL
Last Name:KAHWAJI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2771 ROWENA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-2720
Mailing Address - Country:US
Mailing Address - Phone:323-664-1996
Mailing Address - Fax:323-664-0596
Practice Address - Street 1:2771 ROWENA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-2720
Practice Address - Country:US
Practice Address - Phone:323-664-1996
Practice Address - Fax:323-664-0596
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 5289152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3125OtherMEDICAL EYE SERVICES
8343BOtherVISION SERVICE PLAN
CA46461OtherSAFEGUARD
CA06688OtherSPECTERA
CASD0052891Medicaid
CA06688OtherSPECTERA