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General NPI Number Information
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NPI Number | 1215022967
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Entity Type | Individual
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Provider Name | HENRY RIVERA KAW JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 02/12/2014
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Provider Practice Location Address
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Address Line | 321 N POMONA AVE SUITE B
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City | FULLERTON
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State | CA
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Zip | 92832-1927
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Country | US
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Telephone | 714-462-8383
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Fax | 714-462-8384
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Provider Business Mailing Address
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Address Line | 321 N POMONA AVE SUITE B
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City | FULLERTON
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State | CA
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Zip | 92832-1927
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Country | US
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Telephone | 714-462-8383
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Fax | 714-462-8384
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A95068
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A95068
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License Number State | CA
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