Basic Information
| Provider Information | |||||||||
| NPI: | 1770747305 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAWASAKI | ||||||||
| FirstName: | MIZIN | ||||||||
| MiddleName: | PARK | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24422 AVENIDA DE LA CARLOTA STE 300 | ||||||||
| Address2: | |||||||||
| City: | LAGUNA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926533628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495992434 | ||||||||
| FaxNumber: | 4995992430 | ||||||||
| Practice Location | |||||||||
| Address1: | 425 HAALAND DR | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | THOUSAND OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913615229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054941948 | ||||||||
| FaxNumber: | 8054941947 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2008 | ||||||||
| LastUpdateDate: | 05/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | G063471 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.