Provider Demographics
NPI:1225353592
Name:KAWANO, JORDAN CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:CHRISTOPHER
Last Name:KAWANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2663 CENTINELA AVE UNIT 308
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3156
Mailing Address - Country:US
Mailing Address - Phone:310-600-9117
Mailing Address - Fax:
Practice Address - Street 1:2001 SANTA MONICA BLVD STE 280W
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2172
Practice Address - Country:US
Practice Address - Phone:310-829-7678
Practice Address - Fax:310-829-6889
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA124884207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program