Provider Demographics
NPI:1851460893
Name:KAWARATANI, SUMI KAREN (MD)
Entity Type:Individual
Prefix:
First Name:SUMI
Middle Name:KAREN
Last Name:KAWARATANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUMIKO
Other - Middle Name:K
Other - Last Name:KAWARATANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1245 WILSHIRE BLVD STE 680
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4880
Mailing Address - Country:US
Mailing Address - Phone:213-628-1020
Mailing Address - Fax:
Practice Address - Street 1:1245 WILSHIRE BLVD STE 680
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4880
Practice Address - Country:US
Practice Address - Phone:213-628-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG061755207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0045240Medicaid
CAGR0045240Medicaid
CAE26945Medicare UPIN