Provider Demographics
NPI:1902805914
Name:KANEGAE, THOMAS HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:HENRY
Last Name:KANEGAE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1245 WILSHIRE BLVD
Mailing Address - Street 2:#804
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4810
Mailing Address - Country:US
Mailing Address - Phone:213-977-1030
Mailing Address - Fax:213-977-0379
Practice Address - Street 1:1245 WILSHIRE BLVD
Practice Address - Street 2:STE 804
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4810
Practice Address - Country:US
Practice Address - Phone:213-977-1030
Practice Address - Fax:213-977-0379
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2011-12-08
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Provider Licenses
StateLicense IDTaxonomies
CAG25710207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA42767Medicare UPIN