Provider Demographics
NPI:1558314096
Name:SAEKI, WAKANA (MD)
Entity Type:Individual
Prefix:
First Name:WAKANA
Middle Name:
Last Name:SAEKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 WILSHIRE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5627
Mailing Address - Country:US
Mailing Address - Phone:310-575-3100
Mailing Address - Fax:310-575-3102
Practice Address - Street 1:1821 WILSHIRE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5627
Practice Address - Country:US
Practice Address - Phone:310-575-3100
Practice Address - Fax:310-575-3102
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61896207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0091750Medicaid
G75172Medicare UPIN
CAWA61896BMedicare ID - Type Unspecified