MEDICARE: KAI KEIZO KAWASUGI DDS

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	1223G0001X	General Practice Dentistry	8804	CO

General Provider Information

NPI Number	:	1336140102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAI KEIZO KAWASUGI DDS

Provider Business Mailing Address
First Line	:	1547 HYACINTH WAY
Second Line	:
City	:	SUPERIOR
State	:	CO
Zip	:	80027-6034
Country	:	US
Telephone Number	:	303-499-9125
Fax Number	:

Provider Business Practice Location Address
First Line	:	5169 W 64TH AVE
Second Line	:
City	:	ARVADA
State	:	CO
Zip	:	80003-6531
Country	:	US
Telephone Number	:	303-926-4050
Fax Number	:	303-426-4634

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	07/08/2007

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