Provider Demographics
NPI:1316526577
Name:KAWAGOE, REBECCA RACHEL KING (DO)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:RACHEL KING
Last Name:KAWAGOE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2059 HILLMAN ST
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-1609
Mailing Address - Country:US
Mailing Address - Phone:559-605-0090
Mailing Address - Fax:
Practice Address - Street 1:2059 HILLMAN ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-1609
Practice Address - Country:US
Practice Address - Phone:559-605-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A20472207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty