Healthcare Provider Details

I. General information

NPI: 1053825604
Provider Name (Legal Business Name): KEN UEKAWA MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2017
Last Update Date: 11/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 MAIN ST APT 10A
NEW YORK NY
10044-0318
US

IV. Provider business mailing address

407 E 61ST ST
NEW YORK NY
10065-8736
US

V. Phone/Fax

Practice location:
  • Phone: 917-446-0095
  • Fax:
Mailing address:
  • Phone: 646-962-8260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: