Healthcare Provider Details

I. General information

NPI: 1407634538
Provider Name (Legal Business Name): KIMBERLY CHIYO KUWATA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E WARDLOW RD
LONG BEACH CA
90807-4630
US

IV. Provider business mailing address

900 E WARDLOW RD
LONG BEACH CA
90807-4630
US

V. Phone/Fax

Practice location:
  • Phone: 562-955-6934
  • Fax:
Mailing address:
  • Phone: 562-955-6934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number15026
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: