Provider Demographics
NPI:1215022967
Name:KAW, HENRY RIVERA JR (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:RIVERA
Last Name:KAW
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:321 N POMONA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1927
Mailing Address - Country:US
Mailing Address - Phone:714-462-8383
Mailing Address - Fax:714-462-8384
Practice Address - Street 1:321 N POMONA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1927
Practice Address - Country:US
Practice Address - Phone:714-462-8383
Practice Address - Fax:714-462-8384
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2014-02-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA95068207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI65681Medicare UPIN