Provider Demographics
NPI:1730792144
Name:KANZAWA, PAUL MICHIHIDE (CO)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:MICHIHIDE
Last Name:KANZAWA
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:MICHIHIDE
Other - Last Name:KANZAWA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:12200 WASHINGTON BLVD STE M
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90606-2579
Mailing Address - Country:US
Mailing Address - Phone:562-945-4920
Mailing Address - Fax:562-945-9360
Practice Address - Street 1:12200 WASHINGTON BLVD STE M
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90606-2579
Practice Address - Country:US
Practice Address - Phone:562-945-4920
Practice Address - Fax:562-945-9360
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00031048222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGXC000190OtherMEDICAL