Healthcare Provider Details

I. General information

NPI: 1063091734
Provider Name (Legal Business Name): KEITH M SAKATA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 S SAN ANTONIO RD STE 2
LOS ALTOS CA
94022-3055
US

IV. Provider business mailing address

3061 FILLMORE ST
SAN FRANCISCO CA
94123-4009
US

V. Phone/Fax

Practice location:
  • Phone: 310-601-5099
  • Fax: 888-988-1786
Mailing address:
  • Phone: 213-455-5033
  • Fax: 888-988-1786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA182065
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA182065
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: