Provider Demographics
NPI:1780653287
Name:FRED Y. SAKURAI, M.D.
Entity Type:Organization
Organization Name:FRED Y. SAKURAI, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:YUTAKA
Authorized Official - Last Name:SAKURAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-316-5659
Mailing Address - Street 1:21320 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE#105
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-5606
Mailing Address - Country:US
Mailing Address - Phone:310-316-5659
Mailing Address - Fax:310-316-5884
Practice Address - Street 1:21320 HAWTHORNE BLVD
Practice Address - Street 2:SUITE#105
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5606
Practice Address - Country:US
Practice Address - Phone:310-316-5659
Practice Address - Fax:310-316-5884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA020888208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA20888Medicare ID - Type UnspecifiedMEDICARE
CAA82303Medicare UPIN