Provider Demographics
NPI:1053825604
Name:UEKAWA, KEN (MD, PHD)
Entity type:Individual
Prefix:
First Name:KEN
Middle Name:
Last Name:UEKAWA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 E 61ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8736
Mailing Address - Country:US
Mailing Address - Phone:646-962-8260
Mailing Address - Fax:
Practice Address - Street 1:465 MAIN ST APT 10A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10044-0318
Practice Address - Country:US
Practice Address - Phone:917-446-0095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1102XOther Service ProvidersSpecialistResearch Study
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNON