Provider Demographics
NPI:1568786176
Name:KASUGA, DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:KASUGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 CURIE DR STE 3800
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2985
Mailing Address - Country:US
Mailing Address - Phone:915-532-3912
Mailing Address - Fax:915-542-3436
Practice Address - Street 1:1700 CURIE DR STE 3800
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2985
Practice Address - Country:US
Practice Address - Phone:915-532-3912
Practice Address - Fax:915-542-3436
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ8731207WX0107X
AL33313207W00000X
NMMD2016-0494207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL161693Medicaid