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General NPI Number Information
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NPI Number | 1598774143
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Entity Type | Individual
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Provider Name | DAVID JUN KUMASAKA MD
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Gender | Male
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 09/25/2023
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Provider Practice Location Address
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Address Line | 1200 N BEAVER ST
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3118
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Country | US
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Telephone | 928-779-3366
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Fax |
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Provider Business Mailing Address
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Address Line | 921 W GRAND CANYON AVE
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-5416
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Country | US
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Telephone | 928-699-5217
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 30832
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License Number State | AZ
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