Provider Demographics
NPI:1578116661
Name:IMAI, DAISUKE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAISUKE
Middle Name:
Last Name:IMAI
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:PO BOX 980645
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-0645
Mailing Address - Country:US
Mailing Address - Phone:804-828-7874
Mailing Address - Fax:
Practice Address - Street 1:1200 E BROAD ST FL 15
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5025
Practice Address - Country:US
Practice Address - Phone:804-828-9298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101272331204F00000X, 204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery