Healthcare Provider Details

I. General information

NPI: 1982969838
Provider Name (Legal Business Name): BRIAN TAKESHI KAWASAKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2012
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 CHESTNUT AVE
LONG BEACH CA
90813-2944
US

IV. Provider business mailing address

1333 CHESTNUT AVE
LONG BEACH CA
90813-2944
US

V. Phone/Fax

Practice location:
  • Phone: 562-753-2300
  • Fax:
Mailing address:
  • Phone: 562-753-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA126912
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: