Provider Demographics
NPI:1316951171
Name:KAWANA, ALEX Y (MD)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:Y
Last Name:KAWANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 48107
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-0107
Mailing Address - Country:US
Mailing Address - Phone:323-525-1118
Mailing Address - Fax:818-303-1306
Practice Address - Street 1:8737 BEVERLY BLVD
Practice Address - Street 2:SUITE # 203
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1828
Practice Address - Country:US
Practice Address - Phone:323-525-1111
Practice Address - Fax:323-525-1100
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68665174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATIN 954712812OtherSYNERGY
CA00G146670Medicaid
CAWG68665EMedicare PIN
CAWG68665CMedicare PIN
CATIN 954712812OtherSYNERGY