Provider Demographics
NPI:1710511605
Name:SASAKI, JESI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JESI
Middle Name:
Last Name:SASAKI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13930 NW PASSAGE APT 210
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-7497
Mailing Address - Country:US
Mailing Address - Phone:808-285-5512
Mailing Address - Fax:
Practice Address - Street 1:13930 NW PASSAGE APT 210
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-7497
Practice Address - Country:US
Practice Address - Phone:808-285-5512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30899103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical