Provider Demographics
NPI:1497418982
Name:SASAKI, DAVID (LMFT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SASAKI
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 QUAIL ST STE 200
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2761
Mailing Address - Country:US
Mailing Address - Phone:949-639-9599
Mailing Address - Fax:
Practice Address - Street 1:1400 QUAIL ST STE 200
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2761
Practice Address - Country:US
Practice Address - Phone:949-639-9599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86522106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist