MEDICARE: KAYDEN DANGREMOND

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	363AS0400X	Surgical Physician Assistant
2	363AM0700X	Medical Physician Assistant
3	363AM0700X	Medical Physician Assistant	10425	AZ

General Provider Information

NPI Number	:	1558113423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYDEN DANGREMOND

Provider Business Mailing Address
First Line	:	5901 W BEHREND DR APT 2110
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-6953
Country	:	US
Telephone Number	:	719-337-1250
Fax Number	:

Provider Business Practice Location Address
First Line	:	4790 S CALLE SANTA CRUZ
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85714-0007
Country	:	US
Telephone Number	:	520-777-2277
Fax Number	:

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

Provider Enumeration Date	:	04/03/2024
Last Update Date	:	01/05/2026

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Directions to “ KAYDEN DANGREMOND ” Practice Location

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