Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 054862 | NY |
NPI | 1003023029 |
---|---|
Provider Name | Dr. Takehiro Kasahara |
First Address | New York, NY 10025-1716 |
Second Address | New York, NY 10025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 14/08/2018 |