Provider Demographics
NPI:1548221542
Name:KASAMATSU, GRACE MARI (MD)
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:MARI
Last Name:KASAMATSU
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Gender:F
Credentials:MD
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Mailing Address - Street 1:17742 BEACH BLVD.,
Mailing Address - Street 2:SUITE 240
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647
Mailing Address - Country:US
Mailing Address - Phone:714-842-0444
Mailing Address - Fax:714-842-8444
Practice Address - Street 1:17742 BEACH BLVD,
Practice Address - Street 2:SUITE 240
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647
Practice Address - Country:US
Practice Address - Phone:714-842-0444
Practice Address - Fax:714-842-8444
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2012-06-11
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Provider Licenses
StateLicense IDTaxonomies
CAG0799302080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine