Provider Demographics
NPI:1053303115
Name:SAWADA, KATHLEEN YUMI (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:YUMI
Last Name:SAWADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16608 W 69TH CIR
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80007-7675
Mailing Address - Country:US
Mailing Address - Phone:303-422-3843
Mailing Address - Fax:303-422-1215
Practice Address - Street 1:400 INDIANA ST
Practice Address - Street 2:SUITE 390
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-5027
Practice Address - Country:US
Practice Address - Phone:303-463-9600
Practice Address - Fax:303-403-9919
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO25124207N00000X
GA027907207N00000X
VA0101042631207N00000X
NC39079207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C500048Medicare ID - Type Unspecified
E67535Medicare UPIN