Healthcare Provider Details

I. General information

NPI: 1528366143
Provider Name (Legal Business Name): NICOLE SAKAI D.D.S., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2011
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11340 W OLYMPIC BLVD STE 337
LOS ANGELES CA
90064-1613
US

IV. Provider business mailing address

11340 W OLYMPIC BLVD STE 337
LOS ANGELES CA
90064-1613
US

V. Phone/Fax

Practice location:
  • Phone: 310-479-8900
  • Fax:
Mailing address:
  • Phone: 310-479-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number63446
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number26311
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number63446
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: