1902959323 NPI number — DR. AI SAKONJU M.D.

Table of content: DR. AI SAKONJU M.D. (NPI 1902959323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902959323 NPI number — DR. AI SAKONJU M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAKONJU
Provider First Name:
AI
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:
1902959323
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
SUNY UPSTATE MEDICAL UNIVERSITY
Provider Second Line Business Mailing Address:
750 EAST ADAMS STREET, DEPT. OF NEUROLOGY
Provider Business Mailing Address City Name:
SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-464-5302
Provider Business Mailing Address Fax Number:
315-464-7328

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 MARIO CAPECCHI DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84113-1103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-587-7575
Provider Business Practice Location Address Fax Number:
801-662-5696
Provider Enumeration Date:
01/19/2007

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: 2084N0402X , with the licence number:  P17236 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com