MEDICARE: DR. SUSAN KAWESKI M.D., F.A.C.S.

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	170100000X	Ph.D. Medical Genetics	G53909	PA
2	2086S0122X	Plastic and Reconstructive Surgery Physician	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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629076856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN KAWESKI M.D., F.A.C.S.

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	:	616-464-9877

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	04/04/2018

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