MEDICARE: SUSAN KAWESKI, M.D. A PROFESSIONAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	G53909	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1629076856	OTHER	CA	NPI

General Provider Information

NPI Number	:	1154516243
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN KAWESKI, M.D. A PROFESSIONAL

Provider Business Mailing Address
First Line	:	8415 GRANT AVE.
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941
Country	:	US
Telephone Number	:	619-464-9876
Fax Number	:	619-464-9877

Provider Business Practice Location Address
First Line	:	8415 GRANT AVE
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-5303
Country	:	US
Telephone Number	:	619-464-9876
Fax Number	:	619-464-9877

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SUSAN KAWESKI
Credential	:	M.D.
Telephone Number	:	619-464-9876

Provider Enumeration Date	:	09/11/2007
Last Update Date	:	06/11/2009

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