Healthcare Provider Details

I. General information

NPI: 1700485547
Provider Name (Legal Business Name): DAISUKE KANEYUKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2020
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 W REDWOOD ST STE 300
BALTIMORE MD
21201-7003
US

IV. Provider business mailing address

PO BOX 64226
BALTIMORE MD
21264-4226
US

V. Phone/Fax

Practice location:
  • Phone: 667-214-1734
  • Fax: 410-706-6976
Mailing address:
  • Phone: 667-214-1734
  • Fax: 410-706-6976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberD0107982
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number325332
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number30688
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberLT000898
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: