MEDICARE: DR. ROBERT TSUKASA IMAGAWA D.D.S.

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	D23518	CA

General Provider Information

NPI Number	:	1578595823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT TSUKASA IMAGAWA D.D.S.

Provider Business Mailing Address
First Line	:	490 POST ST
Second Line	:	SUITE 1508
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94102-1401
Country	:	US
Telephone Number	:	415-391-6582
Fax Number	:	415-391-6679

Provider Business Practice Location Address
First Line	:	490 POST ST
Second Line	:	SUITE 1508
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94102-1401
Country	:	US
Telephone Number	:	415-391-6582
Fax Number	:	415-391-6679

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	07/08/2007

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