Provider Demographics
NPI:1568775195
Name:KAWA, DALANDA
Entity Type:Individual
Prefix:
First Name:DALANDA
Middle Name:
Last Name:KAWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 BARD DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-7568
Mailing Address - Country:US
Mailing Address - Phone:972-489-0139
Mailing Address - Fax:214-703-9929
Practice Address - Street 1:922 BARD DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-7568
Practice Address - Country:US
Practice Address - Phone:972-489-0139
Practice Address - Fax:214-703-9929
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-25
Last Update Date:2010-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010902251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX747331Medicare Oscar/Certification