Provider Demographics
NPI:1225250103
Name:DAN K SAKAMOTO M D MEDICAL CORP
Entity Type:Organization
Organization Name:DAN K SAKAMOTO M D MEDICAL CORP
Other - Org Name:DAN K SAKAMOTO M D MEDICAL CORP
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:SETSUKO
Authorized Official - Last Name:KAWACHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-378-7474
Mailing Address - Street 1:23609 HAWTHORNE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6023
Mailing Address - Country:US
Mailing Address - Phone:310-378-7474
Mailing Address - Fax:310-378-5454
Practice Address - Street 1:23609 HAWTHORNE BLVD STE A
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6023
Practice Address - Country:US
Practice Address - Phone:310-378-7474
Practice Address - Fax:310-378-5454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG23249207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41892Medicare UPIN
CAI16463Medicare UPIN