Provider Demographics
NPI:1093758484
Name:SASAKI, TRUMAN M (MD)
Entity Type:Individual
Prefix:
First Name:TRUMAN
Middle Name:M
Last Name:SASAKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97281-3200
Mailing Address - Country:US
Mailing Address - Phone:800-261-8373
Mailing Address - Fax:503-968-4660
Practice Address - Street 1:2055 EXCHANGE ST
Practice Address - Street 2:SUITE 290
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3419
Practice Address - Country:US
Practice Address - Phone:503-338-5353
Practice Address - Fax:503-338-5252
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD09424208600000X, 2086S0129X
WAMD00043729208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR856096000OtherREGENCE BC/BS
OR246397Medicaid
WA0188115OtherDEPT OF L&I
ORP00245484OtherRR MEDICARE
WA1121193Medicaid
OR246397Medicaid
WA1121193Medicaid