Healthcare Provider Details

I. General information

NPI: 1952360356
Provider Name (Legal Business Name): SHIRLEY KIYOKO SAWAI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 06/30/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 HOPE DRIVE STE 202/204
HERSHEY PA
17033-2086
US

IV. Provider business mailing address

21147 W MAIN ST
BUCKEYE AZ
85396-7647
US

V. Phone/Fax

Practice location:
  • Phone: 717-531-3503
  • Fax: 717-531-4375
Mailing address:
  • Phone: 602-791-3096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number2022017758
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number20295
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberG88794
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number01089085B
License Number StateIN
# 5
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberMD472869
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier056813
Identifier TypeMEDICAID
Identifier StateAZ
Identifier Issuer
# 2
IdentifierU3803
Identifier TypeMEDICAID
Identifier StateNM
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: