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NPI Code Detail

MEDICARE: KASAMA PHILLY

MEDICARE: KASAMA PHILLY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QH0100XHealth Service Clinic/Center

General Provider Information

NPI Number : 1205670734
Entity Type Code : Organization
Provider Name (Legal Business Name) : KASAMA PHILLY
Provider Business Mailing Address
First Line : 2418 E YORK ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19125-3006
Country : US
Telephone Number : 267-217-6438
Fax Number : 806-454-5682
Provider Business Practice Location Address
First Line : 2418 E YORK ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19125-3006
Country : US
Telephone Number : 267-217-6438
Fax Number : 806-454-5682
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : DR. MARISSA TAN
Credential : DO
Telephone Number : 814-207-9701
Provider Enumeration Date : 06/20/2024
Last Update Date : 06/20/2024

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Directions to “KASAMA PHILLY ” Practice Location

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