Provider Demographics
NPI:1972704468
Name:SAKURAI, KENNETH H (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:H
Last Name:SAKURAI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4553 GLENCOE AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-7908
Mailing Address - Country:US
Mailing Address - Phone:310-822-4799
Mailing Address - Fax:310-822-0989
Practice Address - Street 1:4553 GLENCOE AVE STE 215
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-7908
Practice Address - Country:US
Practice Address - Phone:310-822-4799
Practice Address - Fax:310-822-0989
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33657122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist