Provider Demographics
NPI:1912014119
Name:SAKURAI, FRED YUTAKA (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:YUTAKA
Last Name:SAKURAI
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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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
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA82303208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAS0038263OtherDEA REGISTRATION NUMBER
CAAS0038263OtherDEA REGISTRATION NUMBER
CAA82303Medicare UPIN