Provider Demographics
NPI:1285643536
Name:KUWATA, JOHN H (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:KUWATA
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 1:3475 TORRANCE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-5800
Mailing Address - Country:US
Mailing Address - Phone:310-370-3568
Mailing Address - Fax:310-318-9188
Practice Address - Street 1:3475 TORRANCE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5800
Practice Address - Country:US
Practice Address - Phone:310-370-3568
Practice Address - Fax:310-318-9188
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45855207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Not Answered207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G458550Medicaid
CA00G458550OtherBLUE CROSS BLUE SHIELD
CAG45855AMedicare ID - Type Unspecified
CA00G458550OtherBLUE CROSS BLUE SHIELD