Provider Demographics
NPI:1720504996
Name:SHIROTA, SACHIKO
Entity Type:Individual
Prefix:
First Name:SACHIKO
Middle Name:
Last Name:SHIROTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 SHERWOOD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1334
Mailing Address - Country:US
Mailing Address - Phone:650-285-3308
Mailing Address - Fax:
Practice Address - Street 1:949 SHERWOOD AVE STE 100
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1334
Practice Address - Country:US
Practice Address - Phone:650-285-3308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17565171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist