Provider Demographics
NPI:1669611950
Name:KIDWELL, DAVID WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WILLIAM
Last Name:KIDWELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:450 BAUCHET ST
Mailing Address - Street 2:TWIN TOWERS CORRECTIONAL FACILITY
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-2907
Mailing Address - Country:US
Mailing Address - Phone:213-473-6171
Mailing Address - Fax:213-972-4002
Practice Address - Street 1:450 BAUCHET ST
Practice Address - Street 2:TWIN TOWERS CORRECTIONAL FACILITY
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2907
Practice Address - Country:US
Practice Address - Phone:213-473-6171
Practice Address - Fax:213-972-4002
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG638102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry