Healthcare Provider Details

I. General information

NPI: 1457354391
Provider Name (Legal Business Name): DR. BRIAN KIMKYONE GAW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1669 W AVENUE J SUITE 304
LANCASTER CA
93534-2866
US

IV. Provider business mailing address

1669 W AVENUE J SUITE 304
LANCASTER CA
93534-2866
US

V. Phone/Fax

Practice location:
  • Phone: 661-951-7888
  • Fax: 661-951-8889
Mailing address:
  • Phone: 661-951-7888
  • Fax: 661-951-8889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number28727
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA49005
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: