Provider Demographics
NPI:1417905126
Name:SAKATA, HIDEYUKI (MD)
Entity Type:Individual
Prefix:DR
First Name:HIDEYUKI
Middle Name:
Last Name:SAKATA
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 1:1510 4TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-1717
Mailing Address - Country:US
Mailing Address - Phone:510-525-8980
Mailing Address - Fax:510-525-8982
Practice Address - Street 1:1510 4TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-1717
Practice Address - Country:US
Practice Address - Phone:510-525-8980
Practice Address - Fax:510-525-8982
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55461207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A554660Medicaid
CAP00437700Medicare PIN
00A554661Medicare PIN
CA00A554660Medicaid