Provider Demographics
NPI:1629776976
Name:SAKAMOTO, KATELYN MICHELLE (DC)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:MICHELLE
Last Name:SAKAMOTO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 W SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2037
Mailing Address - Country:US
Mailing Address - Phone:661-575-7220
Mailing Address - Fax:
Practice Address - Street 1:20201 SW BIRCH ST STE 100
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1781
Practice Address - Country:US
Practice Address - Phone:949-259-5054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36573111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor