Provider Demographics
NPI:1780777284
Name:TAIJI KAWAZU, M.D.
Entity type:Organization
Organization Name:TAIJI KAWAZU, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:TAIJI
Authorized Official - Middle Name:
Authorized Official - Last Name:KAWAZU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-343-0285
Mailing Address - Street 1:130 INDEPENDENCE CIR STE 5
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-4918
Mailing Address - Country:US
Mailing Address - Phone:530-343-0285
Mailing Address - Fax:530-343-3259
Practice Address - Street 1:130 INDEPENDENCE CIR STE 5
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-4918
Practice Address - Country:US
Practice Address - Phone:530-343-0285
Practice Address - Fax:530-343-3259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA260272084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA26027OtherSTATE ID NO.
CA00A260270Medicaid
CA00A260270Medicare ID - Type Unspecified
CAA26027OtherSTATE ID NO.