Provider Demographics
NPI:1093858961
Name:WATASE, KAZUHIKO
Entity Type:Individual
Prefix:
First Name:KAZUHIKO
Middle Name:
Last Name:WATASE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 WASHINGTON ST SE STE I
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-2713
Mailing Address - Country:US
Mailing Address - Phone:505-266-1752
Mailing Address - Fax:505-262-1213
Practice Address - Street 1:457 WASHINGTON ST SE STE I
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2713
Practice Address - Country:US
Practice Address - Phone:505-266-1752
Practice Address - Fax:505-262-1213
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM344171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist