Healthcare Provider Details

I. General information

NPI: 1093167611
Provider Name (Legal Business Name): CAITLYN KUWATA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2016
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 ZONAL AVENUE OPD 3P22
LOS ANGELES CA
90033
US

IV. Provider business mailing address

34 MAPLE ST
NORWALK CT
06850-3815
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-3638
  • Fax:
Mailing address:
  • Phone: 203-852-2025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberA187662
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number299704
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberNPI
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: