Provider Demographics
NPI:1396931309
Name:IWATA, SHUNPEI KEITH (MD)
Entity type:Individual
Prefix:DR
First Name:SHUNPEI
Middle Name:KEITH
Last Name:IWATA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2275 HUNTINGTON DR
Mailing Address - Street 2:#861
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2640
Mailing Address - Country:US
Mailing Address - Phone:626-535-0900
Mailing Address - Fax:626-389-5479
Practice Address - Street 1:800 FAIRMOUNT AVE STE 410
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3154
Practice Address - Country:US
Practice Address - Phone:626-535-0900
Practice Address - Fax:626-389-5479
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2021-08-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA95845207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine