Healthcare Provider Details

I. General information

NPI: 1316301450
Provider Name (Legal Business Name): KENT OKAWA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 11/27/2023
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 VERDUGO BLVD
GLENDALE CA
91208-1407
US

IV. Provider business mailing address

PO BOX 31309
LOS ANGELES CA
90031-0309
US

V. Phone/Fax

Practice location:
  • Phone: 818-790-7100
  • Fax:
Mailing address:
  • Phone: 818-790-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA144300
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: