1285647834 NPI number — MS. MYRA CHRISTENSEN KAWAGUCHI PHD

Table of content: MS. MYRA CHRISTENSEN KAWAGUCHI PHD (NPI 1285647834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285647834 NPI number — MS. MYRA CHRISTENSEN KAWAGUCHI PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAWAGUCHI
Provider First Name:
MYRA
Provider Middle Name:
CHRISTENSEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHRISTENSEN
Provider Other First Name:
MYRA
Provider Other Middle Name:
JANE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285647834
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 CHARLES AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMHERST
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44001-2084
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-984-4005
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1740 COOPER FOSTER PARK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LORAIN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-282-1383
Provider Business Practice Location Address Fax Number:
440-989-1265
Provider Enumeration Date:
08/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  6107 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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