Provider Demographics
NPI:1417362435
Name:ST. LOUIS, KWESI (MD)
Entity Type:Individual
Prefix:
First Name:KWESI
Middle Name:
Last Name:ST. LOUIS
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 1:5215 TORRANCE BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4009
Mailing Address - Country:US
Mailing Address - Phone:310-316-6190
Mailing Address - Fax:310-540-7362
Practice Address - Street 1:5215 TORRANCE BLVD STE 210
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4009
Practice Address - Country:US
Practice Address - Phone:310-316-6190
Practice Address - Fax:310-540-7362
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-27
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA160826207X00000X
PAMT207280207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA160826OtherMD LICENSE