Provider Demographics
NPI:1649289158
Name:SAKURA, CHESTER Y JR (MD)
Entity type:Individual
Prefix:DR
First Name:CHESTER
Middle Name:Y
Last Name:SAKURA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1020 TIJERAS NE
Mailing Address - Street 2:STE 235
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106
Mailing Address - Country:US
Mailing Address - Phone:505-842-6868
Mailing Address - Fax:505-842-9325
Practice Address - Street 1:1020 TIJERAS NE
Practice Address - Street 2:STE 235
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106
Practice Address - Country:US
Practice Address - Phone:505-842-6868
Practice Address - Fax:505-842-9325
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM772512086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM10256Medicaid
NM10256Medicaid