Provider Demographics
NPI:1861506552
Name:KAW, VICENTE YU JR (MD)
Entity Type:Individual
Prefix:DR
First Name:VICENTE
Middle Name:YU
Last Name:KAW
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 2430
Mailing Address - Street 2:3602 WEST CUMBERLAND AVENUE
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-4430
Mailing Address - Country:US
Mailing Address - Phone:606-242-1330
Mailing Address - Fax:606-242-1337
Practice Address - Street 1:3602 CUMBERLAND AVE
Practice Address - Street 2:ARH PROFESSIONAL BUILDING
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-2614
Practice Address - Country:US
Practice Address - Phone:606-242-1330
Practice Address - Fax:606-242-1337
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2012-07-19
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Provider Licenses
StateLicense IDTaxonomies
KY28663207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64286636Medicaid
C44470Medicare UPIN
KY64286636Medicaid