Provider Demographics
NPI:1477656049
Name:DWABE, KEFAH T (MD)
Entity Type:Individual
Prefix:DR
First Name:KEFAH
Middle Name:T
Last Name:DWABE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4863 EL CAJON BLVD
Mailing Address - Street 2:UNIT # A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-4636
Mailing Address - Country:US
Mailing Address - Phone:714-443-1618
Mailing Address - Fax:619-286-9004
Practice Address - Street 1:4863 EL CAJON BLVD.
Practice Address - Street 2:UNIT # A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115
Practice Address - Country:US
Practice Address - Phone:714-443-1618
Practice Address - Fax:619-286-9004
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2010-06-03
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Provider Licenses
StateLicense IDTaxonomies
CAA94193208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA94193OtherMEDICAL LICENSE