MEDICARE: DAVID KAZMIERCZAK

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	1041C0700X	Clinical Social Worker	LCSW 4193	HI

General Provider Information

NPI Number	:	1568907756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID KAZMIERCZAK

Provider Business Mailing Address
First Line	:	PO BOX 1341
Second Line	:
City	:	PAHOA
State	:	HI
Zip	:	96778-1341
Country	:	US
Telephone Number	:	808-938-6565
Fax Number	:

Provider Business Practice Location Address
First Line	:	14-803A SEAVIEW RD
Second Line	:
City	:	PAHOA
State	:	HI
Zip	:	96778-1341
Country	:	US
Telephone Number	:	808-938-6565
Fax Number	:

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

Provider Enumeration Date	:	12/27/2016
Last Update Date	:	12/27/2016

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