MEDICARE: DR. ELISSA KAWAMOTO AU.D.

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
1	2355A2700X	Audiology Assistant	DA14129	AZ
2	231H00000X	Audiologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DA14129	OTHER		AUDIOLOGY LICENSE NUMBER

General Provider Information

NPI Number	:	1295457844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELISSA KAWAMOTO AU.D.

Provider Business Mailing Address
First Line	:	245 E BELL RD STE B-23
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85022-2353
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	245 E BELL RD STE B-23
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85022-2353
Country	:	US
Telephone Number	:	480-214-4909
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2022
Last Update Date	:	07/14/2025

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