Provider Demographics
NPI:1104922772
Name:LINDON KEN KAWAHARA MD DMD
Entity type:Organization
Organization Name:LINDON KEN KAWAHARA MD DMD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDON
Authorized Official - Middle Name:KEN
Authorized Official - Last Name:KAWAHARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-373-2238
Mailing Address - Street 1:22410 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2539
Mailing Address - Country:US
Mailing Address - Phone:310-373-2238
Mailing Address - Fax:
Practice Address - Street 1:22410 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2539
Practice Address - Country:US
Practice Address - Phone:310-373-2238
Practice Address - Fax:310-373-8238
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LINDON KEN KAWAHARA MD DMD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-14
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051331OtherAMBULATORY SURGICAL CENTER ID NUMBER