Provider Demographics
NPI:1356337554
Name:WAKAKUWA, JASON S (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:S
Last Name:WAKAKUWA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:330 BROOKLINE AVE
Mailing Address - Street 2:DEPARTMENT OF ANESTHESIA, CRITICAL CARE AND PAIN MEDICI
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-667-3112
Mailing Address - Fax:617-754-8791
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:DEPARTMENT OF ANESTHESIA, CRITICAL CARE AND PAIN MEDICI
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-667-3112
Practice Address - Fax:617-754-8791
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2022-05-18
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Provider Licenses
StateLicense IDTaxonomies
MA79935207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3138674Medicaid
MAWAA20030Medicare ID - Type Unspecified
MA3138674Medicaid