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NPI Code Detail

MEDICARE: PHYLLIS K. KAWADA, DDS, MS, A PROFESSIONAL CORPORATION

MEDICARE: PHYLLIS K. KAWADA, DDS, MS, A PROFESSIONAL CORPORATION
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
1261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1639653009
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHYLLIS K. KAWADA, DDS, MS, A PROFESSIONAL CORPORATION
Provider Business Mailing Address
First Line : 15944 LOS SERRANOS COUNTRY CLUB DR STE 100
Second Line :
City : CHINO HILLS
State : CA
Zip : 91709-3254
Country : US
Telephone Number : 909-393-3311
Fax Number : 909-393-3343
Provider Business Practice Location Address
First Line : 15944 LOS SERRANOS COUNTRY CLUB DR STE 100
Second Line :
City : CHINO HILLS
State : CA
Zip : 91709-3254
Country : US
Telephone Number : 909-393-3311
Fax Number : 909-393-3343
Authorized Official
Title or Position : PRESIDENT/OWNER
Name : DR. PHYLLIS KAZUMI KAWADA
Credential : DDS
Telephone Number : 562-690-3750
Provider Enumeration Date : 09/20/2018
Last Update Date : 09/20/2018

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