Healthcare Provider Details

I. General information

NPI: 1457705584
Provider Name (Legal Business Name): DONALD KASITINON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 HARRY HINES BLVD
DALLAS TX
75235-7707
US

IV. Provider business mailing address

5323 HARRY HINES BLVD
DALLAS TX
75390-9087
US

V. Phone/Fax

Practice location:
  • Phone: 214-645-1234
  • Fax: 214-645-0078
Mailing address:
  • Phone: 214-645-1234
  • Fax: 214-645-0078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberS1425
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberS1425
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: