Provider Demographics
NPI:1821105305
Name:OKAWA, TSUYOSHI (MD)
Entity Type:Individual
Prefix:
First Name:TSUYOSHI
Middle Name:
Last Name:OKAWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 N PROSPECT AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3041
Mailing Address - Country:US
Mailing Address - Phone:310-376-8816
Mailing Address - Fax:310-376-2091
Practice Address - Street 1:520 N PROSPECT AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3041
Practice Address - Country:US
Practice Address - Phone:310-376-8816
Practice Address - Fax:310-376-2091
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70549207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A705490Medicaid
CAW470549CMedicare ID - Type UnspecifiedMEDICARE PART B PPIN
CAH51934Medicare UPIN