Provider Demographics
NPI:1700124575
Name:MA, KA WAI
Entity Type:Individual
Prefix:
First Name:KA WAI
Middle Name:
Last Name:MA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:MA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1000 IGNACIO BLVD
Mailing Address - Street 2:UNIT 16
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949
Mailing Address - Country:US
Mailing Address - Phone:808-729-6685
Mailing Address - Fax:
Practice Address - Street 1:1000 IGNACIO BLVD
Practice Address - Street 2:SUITE 16
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-5461
Practice Address - Country:US
Practice Address - Phone:808-729-6685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program