Provider Demographics
NPI:1467654327
Name:TERUKINA, KAWIKA M (MD)
Entity Type:Individual
Prefix:
First Name:KAWIKA
Middle Name:M
Last Name:TERUKINA
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 1:10322 WINYAH BAY LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-7546
Mailing Address - Country:US
Mailing Address - Phone:910-581-3852
Mailing Address - Fax:
Practice Address - Street 1:1775 FORRESTAL DR BLDG 33
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23551-5005
Practice Address - Country:US
Practice Address - Phone:910-440-1568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390200000XOtherMILITARY
390200000XOtherMILITARY