Provider Demographics
NPI:1407191497
Name:SASAGAWA, MASA (ND)
Entity type:Individual
Prefix:DR
First Name:MASA
Middle Name:
Last Name:SASAGAWA
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N 160TH ST
Mailing Address - Street 2:B214
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-5685
Mailing Address - Country:US
Mailing Address - Phone:801-808-6736
Mailing Address - Fax:425-602-3079
Practice Address - Street 1:710 N 160TH ST
Practice Address - Street 2:B214
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-5685
Practice Address - Country:US
Practice Address - Phone:801-808-6736
Practice Address - Fax:425-602-3079
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT1279175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath