Provider Demographics
NPI:1598712275
Name:MASAKI, DAMON ISAMU (MD)
Entity Type:Individual
Prefix:DR
First Name:DAMON
Middle Name:ISAMU
Last Name:MASAKI
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 1:2011 PINTO LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4004
Mailing Address - Country:US
Mailing Address - Phone:702-382-3200
Mailing Address - Fax:702-382-3575
Practice Address - Street 1:2011 PINTO LN
Practice Address - Street 2:SUITE 200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4004
Practice Address - Country:US
Practice Address - Phone:702-382-3200
Practice Address - Fax:702-382-3575
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12209207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV12209OtherMEDICAL LICENSE
CAG45365OtherCALIFORNIA STATE LICENSE
CAG73422Medicare UPIN