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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Monday, April 29, 2024 7:03 PM CDT
Next Update: Tuesday, April 30, 2024 2:50 AM CDT

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KABASAWA, DEREK
Practice Address: 13821 TECHNOLOGY DR. STE B
OKLAHOMA CITY OK 73134

Address last updated on 2/1/2024
Phone #: (405) 451-3454
Fax #:
County: OKLAHOMA
License: 4813
Dated: 7/11/2022
Expires: 3/31/2025
License Type: Physician Assistant
Specialty:
Status: Active
Status Class: Fully Licensed
Restricted to:
CME Year: 2025
Pending and/or Past Disciplinary Actions: No Disciplinary Action Taken.
All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
Locations: Hours: Languages:
13821 TECHNOLOGY DR. STE B
OKLAHOMA CITY OK 73134

Phone #: (405) 451-3454
Fax #:

Hospital Privileges:

None listed

Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
WILLIAM OLIVA MD 32105

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