Healthcare Provider Details

I. General information

NPI: 1992027163
Provider Name (Legal Business Name): SANSHIRO KAWAHARA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2010
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1-53-1 YOYOGI MY TOWER RESIDENCE #1205
SHIBUYA TOKYO
1510053
JP

V. Phone/Fax

Practice location:
  • Phone: 305-355-1122
  • Fax:
Mailing address:
  • Phone: 09087317214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: