Provider Demographics
NPI:1609853092
Name:KWA, RAYMOND E (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:E
Last Name:KWA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:26522 LA ALAMEDA
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6330
Mailing Address - Country:US
Mailing Address - Phone:949-282-1671
Mailing Address - Fax:949-367-0518
Practice Address - Street 1:26800 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 315
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6384
Practice Address - Country:US
Practice Address - Phone:949-364-6000
Practice Address - Fax:949-364-1204
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2021-11-05
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Provider Licenses
StateLicense IDTaxonomies
CAG75909207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G759090Medicaid
CAF82275Medicare UPIN
CAWG75909AMedicare PIN
CAGW257ZMedicare PIN