Provider Demographics
NPI:1891764304
Name:SAKAYE SHIGEKAWA M.D.
Entity Type:Organization
Organization Name:SAKAYE SHIGEKAWA M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAKAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIGEKAWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-413-3115
Mailing Address - Street 1:1511 N BENTON WAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-2218
Mailing Address - Country:US
Mailing Address - Phone:213-413-3115
Mailing Address - Fax:310-545-0871
Practice Address - Street 1:1511 N BENTON WAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-2218
Practice Address - Country:US
Practice Address - Phone:213-413-3115
Practice Address - Fax:310-545-0871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA09493207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A094930Medicaid
CAA09493Medicare ID - Type UnspecifiedMEDICARE
CA00A094930Medicaid