Provider Demographics
NPI:1427103035
Name:KAWACHI, MILDRED MICHIYO (M D)
Entity type:Individual
Prefix:DR
First Name:MILDRED
Middle Name:MICHIYO
Last Name:KAWACHI
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 DWIGHT WAY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2633
Mailing Address - Country:US
Mailing Address - Phone:510-540-8777
Mailing Address - Fax:510-549-9331
Practice Address - Street 1:2006 DWIGHT WAY
Practice Address - Street 2:SUITE 107
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2633
Practice Address - Country:US
Practice Address - Phone:510-540-8777
Practice Address - Fax:510-549-9331
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30058207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G300580Medicaid
CAA44275Medicare UPIN
CA00G300580Medicaid