1649372921 NPI number — MIMI KIYOKO SATO-RE M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649372921 NPI number — MIMI KIYOKO SATO-RE M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SATO-RE

Provider First Name:

MIMI

Provider Middle Name:

KIYOKO

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

SATO

Provider Other First Name:

MIMI

Provider Other Middle Name:

KIYOKO

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

M.D.

Provider Other Last Name Type Code:

1

NPI Number:

1649372921

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

09/04/2019

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1216 SUNCAST LN

Provider Second Line Business Mailing Address:

STE 1

Provider Business Mailing Address City Name:

EL DORADO HILLS

Provider Business Mailing Address State Name:

CA

Provider Business Mailing Address Postal Code:

95762-9668

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

916-292-9777

Provider Business Mailing Address Fax Number:

916-292-9778

Provider First Line Business Practice Location Address:

3160 FOLSOM BLVD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SACRAMENTO

Provider Business Practice Location Address State Name:

CA

Provider Business Practice Location Address Postal Code:

95816-5219

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

916-357-5800

Provider Business Practice Location Address Fax Number:

916-358-5899

Provider Enumeration Date:

09/05/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  A61185 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1145650 . This is a "FIRST HEALTH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: MCMG315500 . This is a "WESTERN HEALTH ADVANTAGE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 36398 . This is a "INTERPLAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 3891177 . This is a "CIGNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 065926 . This is a "HEALTH NET" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 1279210 . This is a "GREAT WEST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 90099431 . This is a "PACIFICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 5089678 . This is a "AETNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 000810793181 . This is a "PHCS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 00A611850 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1815553 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: A61185 . This is a "BLUE CROSS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".