| Doctor Name: | KAI DACOSTA |
| NPI Number: | 1578711016 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DO |
| License Number: | 2155 |
| Business Practice Address: | 9040 Fitzsimmons Dr Tacoma, WA - 984311000 |
| Business Phone Number: | 2539681330 |
| Business Fax Number: | |
| Mailing Address: | Po Box 351, PERRY |
| State: | ME |
| Postal Code: | 046670351 |
| Phone Number: | 2078530644 |
| Fax Number: | 2078532347 |
| NPI Enumeration Date: | 09/08/2008 |
| NPI Last Update Date: | 02/17/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 2155 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ME |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |