MEDICARE: MARITA KAW

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	343900000X	Non-emergency Medical Transport (VAN)	MTN00520F	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

General Provider Information

NPI Number	:	1891882379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARITA KAW

Provider Business Mailing Address
First Line	:	3161 BUTLER AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-1301
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3161 BUTLER AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-1301
Country	:	US
Telephone Number	:	310-313-1111
Fax Number	:

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	MARITA KAW
Credential	:
Telephone Number	:	310-313-1111

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	06/19/2008

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