Healthcare Provider Details

I. General information

NPI: 1386645067
Provider Name (Legal Business Name): KEVIN KUWABARA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E VALENCIA MESA DR SUITE 105
FULLERTON CA
92835-3813
US

IV. Provider business mailing address

279 IMPERIAL HWY SUITE 730
FULLERTON CA
92835-1041
US

V. Phone/Fax

Practice location:
  • Phone: 714-446-5200
  • Fax:
Mailing address:
  • Phone: 714-449-4842
  • Fax: 714-449-4816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberDC 20273
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: