Basic Information
Provider Information
NPI: 1740349489
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KAHWAJI
FirstName: JOSEPH
MiddleName: MICHEL
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 393 E WALNUT ST
Address2: 3RD FLOOR PHR SYSTEMS
City: PASADENA
State: CA
PostalCode: 911880001
CountryCode: US
TelephoneNumber: 6264053640
FaxNumber: 6264056768
Practice Location
Address1: 4760 W SUNSET BLVD
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900276063
CountryCode: US
TelephoneNumber: 3237834011
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/08/2006
LastUpdateDate: 12/01/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RN0300XA84085CAY Allopathic & Osteopathic PhysiciansInternal MedicineNephrology

No ID Information.


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