Basic Information
| Provider Information | |||||||||
| NPI: | 1508273665 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAWABORI | ||||||||
| FirstName: | MASASHI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 33 POND AVE | ||||||||
| Address2: | #504 | ||||||||
| City: | BROOKLINE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024457163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177846480 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021111552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176365594 | ||||||||
| FaxNumber: | 6176366410 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2014 | ||||||||
| LastUpdateDate: | 07/02/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 258748 | MA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.