Healthcare Provider Details

I. General information

NPI: 1578884367
Provider Name (Legal Business Name): KAZUSA ISHII M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CENTER DRIVE BLDG 10, CRC RM 3E-3330
BETHESDA MD
20892-0001
US

IV. Provider business mailing address

10 CENTER DRIVE BLDG 10, CRC RM 3E-3330
BETHESDA MD
20892-0001
US

V. Phone/Fax

Practice location:
  • Phone: 240-281-6858
  • Fax:
Mailing address:
  • Phone: 240-281-6858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberD0077414
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: