Provider Demographics
NPI:1740223619
Name:SAKAMOTO, KYOKO (MD)
Entity Type:Individual
Prefix:DR
First Name:KYOKO
Middle Name:
Last Name:SAKAMOTO
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 1:200 W ARBOR DRIVE
Mailing Address - Street 2:MAIL CODE 8897
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-8897
Mailing Address - Country:US
Mailing Address - Phone:619-543-2628
Mailing Address - Fax:618-543-6573
Practice Address - Street 1:3350 LA JOLLA VILLAGE DRIVE
Practice Address - Street 2:MAIL CODE 9112F
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161-0002
Practice Address - Country:US
Practice Address - Phone:858-552-8585
Practice Address - Fax:858-642-6230
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80808208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A808080Medicaid
CAH21993Medicare UPIN
CA00A808080Medicaid