Provider Demographics
NPI:1962428300
Name:KWAW, ISIDORE KW (MD)
Entity type:Individual
Prefix:
First Name:ISIDORE
Middle Name:KW
Last Name:KWAW
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 5280
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92615-5280
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9201 SUNSET BLVD
Practice Address - Street 2:705
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90069-3708
Practice Address - Country:US
Practice Address - Phone:310-271-2744
Practice Address - Fax:310-276-1732
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66583207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA930114393OtherRAILROAD MEDICARE
CA00G665830OtherBLUE SHIELD
CA00G665830Medicaid
CAF24902Medicare UPIN
CA00G665830Medicaid
CAWG66583IMedicare ID - Type Unspecified
CAWG66583HMedicare ID - Type Unspecified