MEDICARE: KAEDE ALISSA SASAHARA AUD

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	231H00000X	Audiologist	AUD004346	TX

General Provider Information

NPI Number	:	1417672700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAEDE ALISSA SASAHARA AUD

Provider Business Mailing Address
First Line	:	12900 QUEENSBURY LN STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-3714
Country	:	US
Telephone Number	:	713-827-1767
Fax Number	:

Provider Business Practice Location Address
First Line	:	12900 QUEENSBURY LN STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-3714
Country	:	US
Telephone Number	:	713-827-1767
Fax Number	:

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

Provider Enumeration Date	:	10/10/2022
Last Update Date	:	11/17/2025

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