Provider Demographics
NPI:1649372921
Name:SATO-RE, MIMI KIYOKO (MD)
Entity type:Individual
Prefix:
First Name:MIMI
Middle Name:KIYOKO
Last Name:SATO-RE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MIMI
Other - Middle Name:KIYOKO
Other - Last Name:SATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1216 SUNCAST LN
Mailing Address - Street 2:STE 1
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-9668
Mailing Address - Country:US
Mailing Address - Phone:916-292-9777
Mailing Address - Fax:916-292-9778
Practice Address - Street 1:3160 FOLSOM BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5219
Practice Address - Country:US
Practice Address - Phone:916-357-5800
Practice Address - Fax:916-358-5899
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61185207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1145650OtherFIRST HEALTH
CAMCMG315500OtherWESTERN HEALTH ADVANTAGE
CA36398OtherINTERPLAN
CA3891177OtherCIGNA
CA065926OtherHEALTH NET
CA1279210OtherGREAT WEST
CA90099431OtherPACIFICARE
CA5089678OtherAETNA
CA000810793181OtherPHCS
CA00A611850Medicaid
CA1815553OtherUNITED HEALTHCARE
CAA61185OtherBLUE CROSS
CAA61185OtherBLUE CROSS
CA065926OtherHEALTH NET