Individual
DEREK KABASAWA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
13821 TECHNOLOGY DR STE B, OKLAHOMA CITY, OK 73134-1046
(405) 451-3454
Mailing address
13821 TECHNOLOGY DR STE B, OKLAHOMA CITY, OK 73134-1046
(405) 451-3454
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4813
OK
Other
Enumeration date
07/13/2022
Last updated
10/10/2022
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