MEDICARE: DR. JOHN KAWAOKA MD

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	207N00000X	Dermatology Physician	MD12497	RI

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

General Provider Information

NPI Number	:	1689899742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN KAWAOKA MD

Provider Business Mailing Address
First Line	:	15 LA SALLE SQ
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02903-1814
Country	:	US
Telephone Number	:	401-444-6779
Fax Number	:	401-444-6912

Provider Business Practice Location Address
First Line	:	593 EDDY ST APC-10
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02903-4923
Country	:	US
Telephone Number	:	401-444-7959
Fax Number	:	401-444-7144

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

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	12/18/2025

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