Healthcare Provider Details

I. General information

NPI: 1730335845
Provider Name (Legal Business Name): KRISTAL C KAWAMOTO O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2008
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19636 SHERMAN WAY
RESEDA CA
91335-3647
US

IV. Provider business mailing address

20547 PESARO WAY
PORTER RANCH CA
91326-4149
US

V. Phone/Fax

Practice location:
  • Phone: 818-774-2020
  • Fax:
Mailing address:
  • Phone: 818-642-3803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13522
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: