MEDICARE: DR. WAYNE KAZUMI TSUTSUSE 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	26551	CA

General Provider Information

NPI Number	:	1598701765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE KAZUMI TSUTSUSE D.D.S.

Provider Business Mailing Address
First Line	:	1020 SUNCAST LN
Second Line	:	SUITE 103
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-9335
Country	:	US
Telephone Number	:	916-941-2447
Fax Number	:	916-941-2466

Provider Business Practice Location Address
First Line	:	1020 SUNCAST LN
Second Line	:	SUITE 103
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-9335
Country	:	US
Telephone Number	:	916-941-2447
Fax Number	:	916-941-2466

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	07/08/2007

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