Provider Demographics
NPI:1598899957
Name:KASAMATSU, ROBERT KEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KEN
Last Name:KASAMATSU
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 W. IMPERIAL HWY UNIT B
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90303-2252
Mailing Address - Country:US
Mailing Address - Phone:310-673-3338
Mailing Address - Fax:310-671-4243
Practice Address - Street 1:3535 W. IMPERIAL HWY UNIT B
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-2252
Practice Address - Country:US
Practice Address - Phone:310-673-3338
Practice Address - Fax:310-671-4243
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3736213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E37362Medicaid
CAE3736BMedicare ID - Type Unspecified
CA000E37362Medicaid