Healthcare Provider Details

I. General information

NPI: 1457528549
Provider Name (Legal Business Name): KANAKO KAWAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 BIESTERFIELD RD
ELK GROVE VLG IL
60007-3361
US

IV. Provider business mailing address

800 BIESTERFIELD RD
ELK GROVE VLG IL
60007-3361
US

V. Phone/Fax

Practice location:
  • Phone: 630-734-0200
  • Fax:
Mailing address:
  • Phone: 630-734-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036120742
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: