Provider Demographics
NPI:1750453577
Name:OSUGA, JOANNA M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:M
Last Name:OSUGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:MIROKU
Other - Last Name:IKEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2025 MORSE AVE
Mailing Address - Street 2:KAISER FOUNDATION HOSPITAL, EMERGENCY DEPARTMENT
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2115
Mailing Address - Country:US
Mailing Address - Phone:916-973-1655
Mailing Address - Fax:
Practice Address - Street 1:2025 MORSE AVE
Practice Address - Street 2:KAISER FOUNDATION HOSPITAL, EMERGENCY DEPARTMENT
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2115
Practice Address - Country:US
Practice Address - Phone:916-973-1655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69768207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G697680Medicaid
00G697680Medicare ID - Type Unspecified
CA00G697680Medicaid