Provider Demographics
NPI:1831285055
Name:SAKUMA, KAREN DEBRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:DEBRA
Last Name:SAKUMA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-7314
Mailing Address - Country:US
Mailing Address - Phone:425-827-0426
Mailing Address - Fax:425-828-4638
Practice Address - Street 1:5525 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-7314
Practice Address - Country:US
Practice Address - Phone:425-827-0426
Practice Address - Fax:425-828-4638
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000053181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5007224Medicaid