Provider Demographics
NPI:1609927771
Name:KAGAWAN, MARC (RT)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:KAGAWAN
Suffix:
Gender:M
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CORAL SEA ROAD
Mailing Address - Street 2:USCG AIR STATION BARBERS POINT
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707
Mailing Address - Country:US
Mailing Address - Phone:808-682-2673
Mailing Address - Fax:
Practice Address - Street 1:1 CORAL SEA ST
Practice Address - Street 2:USCG AIR STATION BARBERS POINT
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-3693
Practice Address - Country:US
Practice Address - Phone:808-682-2673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other