Provider Demographics
NPI:1235297433
Name:SAKAZAKI, KENNETH K (OD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:K
Last Name:SAKAZAKI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 O ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-5327
Mailing Address - Country:US
Mailing Address - Phone:916-443-3524
Mailing Address - Fax:916-443-3986
Practice Address - Street 1:400 O ST STE 102
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-5327
Practice Address - Country:US
Practice Address - Phone:916-443-3524
Practice Address - Fax:916-443-3986
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8578TPG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0085780Medicaid
CAU30807Medicare UPIN
CASD0085780Medicare PIN
CA0737180001Medicare NSC