MEDICARE: ISIDORE K.W. KWAW MD

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	207P00000X	Emergency Medicine Physician	G66583	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	930114393	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	00G665830	OTHER	CA	BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962428300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISIDORE K.W. KWAW MD

Provider Business Mailing Address
First Line	:	PO BOX 5280
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92615-5280
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9201 SUNSET BLVD
Second Line	:	705
City	:	LOS ANGELES
State	:	CA
Zip	:	90069-3708
Country	:	US
Telephone Number	:	310-271-2744
Fax Number	:	310-276-1732

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

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	11/29/2012

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Directions to “ ISIDORE K.W. KWAW MD” Practice Location

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