Provider Demographics
NPI:1801956842
Name:HENRY K.KAWAMOTO, JR.,M.D,D.D.S.
Entity type:Organization
Organization Name:HENRY K.KAWAMOTO, JR.,M.D,D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:K
Authorized Official - Last Name:KAWAMOTO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD,DDS
Authorized Official - Phone:310-829-0391
Mailing Address - Street 1:1301 20TH ST
Mailing Address - Street 2:#460
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2050
Mailing Address - Country:US
Mailing Address - Phone:310-829-0391
Mailing Address - Fax:310-828-3733
Practice Address - Street 1:1301 20TH ST
Practice Address - Street 2:#460
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2050
Practice Address - Country:US
Practice Address - Phone:310-829-0391
Practice Address - Fax:310-828-3733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA21863174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty