Healthcare Provider Details

I. General information

NPI: 1073452603
Provider Name (Legal Business Name): YASUHIKO KAWAGUCHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LANCASTER AVE
PENN WYNNE PA
19096
US

IV. Provider business mailing address

100 E LANCASTER AVE MEDICAL OFFICE BUILDING EAST, SUITE 356
WYNNEWOOD PA
19096
US

V. Phone/Fax

Practice location:
  • Phone: 484-337-2023
  • Fax: 484-337-3731
Mailing address:
  • Phone: 484-428-0242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD493429
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: