Provider Demographics
NPI:1952301616
Name:KAWAGUCHI, MICHAEL MASAHIKO (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MASAHIKO
Last Name:KAWAGUCHI
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 36900
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-6900
Mailing Address - Country:US
Mailing Address - Phone:702-732-6000
Mailing Address - Fax:702-243-7531
Practice Address - Street 1:2850 SIENA HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4154
Practice Address - Country:US
Practice Address - Phone:702-732-6000
Practice Address - Fax:702-243-7531
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV67532085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV200262809Medicaid
NV30WCHCC12Medicare ID - Type Unspecified
NV200262809Medicaid