Healthcare Provider Details

I. General information

NPI: 1700049350
Provider Name (Legal Business Name): KIMBERLEE ITSUKO SAKAI OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 SPAANS DR STE A
GALT CA
95632-8611
US

IV. Provider business mailing address

730 SPAANS DR STE A
GALT CA
95632-8611
US

V. Phone/Fax

Practice location:
  • Phone: 209-745-2880
  • Fax: 209-745-6840
Mailing address:
  • Phone: 209-745-2880
  • Fax: 209-745-6840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG002104
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13552T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: