Healthcare Provider Details

I. General information

NPI: 1023075397
Provider Name (Legal Business Name): KEN IWAKI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11700 ARTESIA BLVD
ARTESIA CA
90701-3804
US

IV. Provider business mailing address

11700 ARTESIA BLVD
ARTESIA CA
90701-3804
US

V. Phone/Fax

Practice location:
  • Phone: 562-865-0569
  • Fax: 562-865-4854
Mailing address:
  • Phone: 562-865-0569
  • Fax: 562-865-4854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number14406
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC14406
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: