Provider Demographics
NPI:1538103015
Name:KUWAHARA, LISA KAY (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:KAY
Last Name:KUWAHARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-408-2888
Mailing Address - Fax:801-408-2886
Practice Address - Street 1:324 10TH AVE
Practice Address - Street 2:#100
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-2853
Practice Address - Country:US
Practice Address - Phone:801-408-2888
Practice Address - Fax:801-408-2886
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT1848411205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT942854057043Medicaid
UT942854057043Medicaid
UT000063367Medicare PIN