Provider Demographics
NPI:1093928657
Name:BRADLEY W. SAKAGUCHI M.D., LLC
Entity Type:Organization
Organization Name:BRADLEY W. SAKAGUCHI M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:W
Authorized Official - Last Name:SAKAGUCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-536-9368
Mailing Address - Street 1:500 ALA MOANA BLVD
Mailing Address - Street 2:BUILDING 7, SUITE 230
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-4920
Mailing Address - Country:US
Mailing Address - Phone:808-536-9368
Mailing Address - Fax:808-536-9369
Practice Address - Street 1:500 ALA MOANA BLVD
Practice Address - Street 2:BUILDING 7, SUITE 230
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-4920
Practice Address - Country:US
Practice Address - Phone:808-536-9368
Practice Address - Fax:808-536-9369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10052207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty