Healthcare Provider Details

I. General information

NPI: 1457322059
Provider Name (Legal Business Name): DANIEL KASSAYE GAME M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1866 RAOUL WALLENBERG BLVD SUITE B
CHARLESTON SC
29407-3545
US

IV. Provider business mailing address

PO BOX 80054
CHARLESTON SC
29416-0054
US

V. Phone/Fax

Practice location:
  • Phone: 843-766-6646
  • Fax: 843-766-6646
Mailing address:
  • Phone: 843-766-6646
  • Fax: 843-766-6640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number22070
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: