Provider Demographics
NPI:1770669483
Name:LIJUN SAKAL, MD
Entity Type:Organization
Organization Name:LIJUN SAKAL, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:SAKAL
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:530-873-1676
Mailing Address - Street 1:14662 SKYWAY
Mailing Address - Street 2:
Mailing Address - City:MAGALIA
Mailing Address - State:CA
Mailing Address - Zip Code:95954-9356
Mailing Address - Country:US
Mailing Address - Phone:530-873-1676
Mailing Address - Fax:530-873-2643
Practice Address - Street 1:14662 SKYWAY
Practice Address - Street 2:
Practice Address - City:MAGALIA
Practice Address - State:CA
Practice Address - Zip Code:95954-9356
Practice Address - Country:US
Practice Address - Phone:530-873-1676
Practice Address - Fax:530-873-2643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79563261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM53965FMedicaid
CAH70793Medicare UPIN
CARHM53965FMedicaid