Provider Demographics
NPI:1225119530
Name:SAKURAI, KAORI A (MD)
Entity Type:Individual
Prefix:DR
First Name:KAORI
Middle Name:A
Last Name:SAKURAI
Suffix:
Gender:F
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 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-286-2700
Mailing Address - Fax:314-983-0155
Practice Address - Street 1:10 BARNES WEST DR
Practice Address - Street 2:DIV IM GERIATRICS, STE 200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6287
Practice Address - Country:US
Practice Address - Phone:314-286-2700
Practice Address - Fax:314-983-0155
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113012207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208388603Medicaid
MO1101941OtherBNDD
MO208388603Medicaid
MO113012OtherMEDICAL LICENSE
MOBS6715203OtherDEA
MO208388603Medicaid