Provider Demographics
NPI:1871375444
Name:KAJIWARA, MEGAN JOY (WHNP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:JOY
Last Name:KAJIWARA
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 BIRCH STREET
Mailing Address - Street 2:
Mailing Address - City:LAKE ISABELLA
Mailing Address - State:CA
Mailing Address - Zip Code:93240
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4300 BIRCH STREET
Practice Address - Street 2:
Practice Address - City:MOUNTAIN MESA
Practice Address - State:CA
Practice Address - Zip Code:93240
Practice Address - Country:US
Practice Address - Phone:760-379-1791
Practice Address - Fax:760-379-1793
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027749363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health