Provider Demographics
NPI:1881681229
Name:KAWASE, YUTAKA (MD)
Entity Type:Individual
Prefix:DR
First Name:YUTAKA
Middle Name:
Last Name:KAWASE
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 741331
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1331
Mailing Address - Country:US
Mailing Address - Phone:913-469-0503
Mailing Address - Fax:913-469-5267
Practice Address - Street 1:15101 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:KS
Practice Address - Zip Code:66223-3154
Practice Address - Country:US
Practice Address - Phone:913-681-8866
Practice Address - Fax:913-338-1311
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0424365207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
5534061AMedicare ID - Type Unspecified
D81908Medicare UPIN