MEDICARE: DR. DENISE KAYSER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	A66761	CA
2	207W00000X	Ophthalmology Physician	64149	AZ
3	207WX0107X	Retina Specialist (Ophthalmology) Physician	A66761	CA
4	207WX0107X	Retina Specialist (Ophthalmology) Physician	64149	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00058640	OTHER	CA	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	A66761	OTHER	CA	STATE MEDICAL LICENSE

General Provider Information

NPI Number	:	1134122633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENISE KAYSER M.D.

Provider Business Mailing Address
First Line	:	4045 E UNION HILLS DR STE 115
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-3388
Country	:	US
Telephone Number	:	602-368-3448
Fax Number	:

Provider Business Practice Location Address
First Line	:	3536 MENDOCINO AVE
Second Line	:	STE 380
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-3612
Country	:	US
Telephone Number	:	707-575-5353
Fax Number	:	707-523-7733

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	08/03/2021

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Directions to “ DR. DENISE KAYSER M.D.” Practice Location

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