MEDICARE: DR. BEN R KAWATA DDS

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	122300000X	Dentist	36948	CA

General Provider Information

NPI Number	:	1528226503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BEN R KAWATA DDS

Provider Business Mailing Address
First Line	:	12211 W PICO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1134
Country	:	US
Telephone Number	:	310-826-6123
Fax Number	:	310-207-8686

Provider Business Practice Location Address
First Line	:	12211 W PICO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1134
Country	:	US
Telephone Number	:	310-826-6123
Fax Number	:	310-207-8686

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2008
Last Update Date	:	05/27/2008

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