Provider Demographics
NPI:1821044819
Name:KAW, MATTHEW KM (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:KM
Last Name:KAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KYAW
Other - Middle Name:N
Other - Last Name:MAUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4355 PECK RD
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732-1905
Mailing Address - Country:US
Mailing Address - Phone:626-575-4511
Mailing Address - Fax:626-575-4512
Practice Address - Street 1:4355 PECK RD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-1905
Practice Address - Country:US
Practice Address - Phone:626-575-4511
Practice Address - Fax:626-575-4512
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88602207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A886020Medicaid
CAI33491Medicare UPIN
CAA88602Medicare ID - Type UnspecifiedMEDICARE ID NUMBER