MEDICARE: MR. CARL KIYOSHI KAWAKAMI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LSW-479	HI

General Provider Information

NPI Number	:	1649498361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CARL KIYOSHI KAWAKAMI

Provider Business Mailing Address
First Line	:	45-106 LELEUA PL
Second Line	:
City	:	KANEOHE
State	:	HI
Zip	:	96744-2123
Country	:	US
Telephone Number	:	808-235-8633
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 S BERETANIA ST
Second Line	:	SUITE 402
City	:	HONOLULU
State	:	HI
Zip	:	96826-1932
Country	:	US
Telephone Number	:	808-945-3690
Fax Number	:	808-945-2811

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	07/08/2007

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