Provider Demographics
NPI:1437633872
Name:PHYLLIS K. KAWADA, DDS, MS, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:PHYLLIS K. KAWADA, DDS, MS, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:KAZUMI
Authorized Official - Last Name:KAWADA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-690-3750
Mailing Address - Street 1:731 N BEACH BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-3690
Mailing Address - Country:US
Mailing Address - Phone:562-690-3750
Mailing Address - Fax:
Practice Address - Street 1:731 N BEACH BLVD STE 120
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-3690
Practice Address - Country:US
Practice Address - Phone:562-226-1636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical