Provider Demographics
NPI:1982022166
Name:SAKO, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:SAKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 COLLINS DR APT 6
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-3170
Mailing Address - Country:US
Mailing Address - Phone:562-400-7577
Mailing Address - Fax:
Practice Address - Street 1:388 E YOSEMITE AVE STE 100
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-8219
Practice Address - Country:US
Practice Address - Phone:209-722-7801
Practice Address - Fax:904-384-3613
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA137676207ND0101X, 207N00000X
390200000X
FLME138612207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program