Provider Demographics
NPI:1508183823
Name:GREG K SAKAMOTO MD LLC
Entity Type:Organization
Organization Name:GREG K SAKAMOTO MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:K
Authorized Official - Last Name:SAKAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-447-7454
Mailing Address - Street 1:550 S BERETANIA ST
Mailing Address - Street 2:STE 603
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2414
Mailing Address - Country:US
Mailing Address - Phone:808-447-7454
Mailing Address - Fax:808-447-7456
Practice Address - Street 1:550 S BERETANIA ST
Practice Address - Street 2:STE 603
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2414
Practice Address - Country:US
Practice Address - Phone:808-447-7454
Practice Address - Fax:808-447-7456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-14900207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIDF520AMedicare UPIN