1740223619 NPI number — DR. KYOKO SAKAMOTO M.D

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740223619 NPI number — DR. KYOKO SAKAMOTO M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAKAMOTO
Provider First Name:
KYOKO
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740223619
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 W ARBOR DRIVE
Provider Second Line Business Mailing Address:
MAIL CODE 8897
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92103-8897
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-543-2628
Provider Business Mailing Address Fax Number:
618-543-6573

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3350 LA JOLLA VILLAGE DRIVE
Provider Second Line Business Practice Location Address:
MAIL CODE 9112F
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92161-0002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-552-8585
Provider Business Practice Location Address Fax Number:
858-642-6230
Provider Enumeration Date:
06/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  A80808 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A808080 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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