Healthcare Provider Details

I. General information

NPI: 1497189658
Provider Name (Legal Business Name): MIMI OGAWA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2013
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 HOSPITAL DR SUITE 103
SACRAMENTO CA
95823-5408
US

IV. Provider business mailing address

2344 6TH ST
BERKELEY CA
94710-2412
US

V. Phone/Fax

Practice location:
  • Phone: 916-681-1600
  • Fax: 916-688-0226
Mailing address:
  • Phone: 510-981-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA127023
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: