Provider Demographics
NPI:1588630297
Name:MUKAI, ELIZABETH SAYURI (OD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:SAYURI
Last Name:MUKAI
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:2733 E MARIQUITA ST
Mailing Address - Street 2:APT. #104
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-5452
Mailing Address - Country:US
Mailing Address - Phone:562-688-7030
Mailing Address - Fax:
Practice Address - Street 1:35 LINDEN AVE
Practice Address - Street 2:SUITE #102
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-5000
Practice Address - Country:US
Practice Address - Phone:562-435-2020
Practice Address - Fax:562-435-2026
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT10664T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU62748Medicare UPIN