Provider Demographics
NPI:1245348994
Name:KAWANO, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:KAWANO
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 1:1 BAYWOOD AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402
Mailing Address - Country:US
Mailing Address - Phone:650-348-8676
Mailing Address - Fax:650-579-4407
Practice Address - Street 1:1 BAYWOOD AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402
Practice Address - Country:US
Practice Address - Phone:650-348-8676
Practice Address - Fax:650-579-4407
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53807207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
196971700OtherDEPT OF LABOR
CA00G538070Medicaid
196971700OtherDEPT OF LABOR
CA00G538070Medicaid