Provider Demographics
NPI:1043829625
Name:SASAKI MEDICAL LLC
Entity Type:Organization
Organization Name:SASAKI MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALANA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SASAKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-447-3755
Mailing Address - Street 1:777 RAYMOND AVE
Mailing Address - Street 2:
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114
Mailing Address - Country:US
Mailing Address - Phone:651-447-3755
Mailing Address - Fax:651-444-8923
Practice Address - Street 1:1919 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:651-447-3755
Practice Address - Fax:651-444-8923
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SASAKI MEDICAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty