Healthcare Provider Details

I. General information

NPI: 1568463537
Provider Name (Legal Business Name): GARY MARK SATOU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10833 LE CONTE AVE
LOS ANGELES CA
90095
US

IV. Provider business mailing address

10833 LE CONTE AVE
LOS ANGELES CA
90095-3075
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-5296
  • Fax: 310-825-9524
Mailing address:
  • Phone: 310-825-5296
  • Fax: 310-825-9524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number213923
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberG8095
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: