Healthcare Provider Details

I. General information

NPI: 1972992287
Provider Name (Legal Business Name): KENT IWAI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2015
Last Update Date: 01/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 S GARFIELD AVE
ALHAMBRA CA
91801-3838
US

IV. Provider business mailing address

1000 N LAS FLORES AVE
MONTEBELLO CA
90640-2777
US

V. Phone/Fax

Practice location:
  • Phone: 626-282-3151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2846
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: