Organization
KASAMA PHILLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARISSA TAN DO (MEDICAL DIRECTOR)
(814) 207-9701
Entity
Organization
Contact information
Practice address
2418 E YORK ST, PHILADELPHIA, PA 19125-3006
(267) 217-6438
(806) 454-5682
Mailing address
2418 E YORK ST, PHILADELPHIA, PA 19125-3006
(267) 217-6438
(806) 454-5682
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
06/20/2024
Last updated
06/20/2024
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