Provider Demographics
NPI:1457863284
Name:MONDA, DAISUKE
Entity Type:Individual
Prefix:
First Name:DAISUKE
Middle Name:
Last Name:MONDA
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 1:1225 COTTONWOOD ST APT 13
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-5296
Mailing Address - Country:US
Mailing Address - Phone:620-487-4820
Mailing Address - Fax:
Practice Address - Street 1:1225 COTTONWOOD ST APT 13
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-5296
Practice Address - Country:US
Practice Address - Phone:620-487-4820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program