Provider Demographics
NPI:1255524328
Name:KUWADA, CLINTON AKIRA (MD)
Entity type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:AKIRA
Last Name:KUWADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:988 SILAS DEANE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109
Mailing Address - Country:US
Mailing Address - Phone:860-493-1950
Mailing Address - Fax:860-493-1961
Practice Address - Street 1:85 SEYMOUR ST STE 318
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5522
Practice Address - Country:US
Practice Address - Phone:860-493-1950
Practice Address - Fax:860-493-1961
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT50623207Y00000X
CT050623207Y00000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008041202Medicaid