Healthcare Provider Details

I. General information

NPI: 1053700807
Provider Name (Legal Business Name): MATTHEW SAKUMOTO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2015
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 PARNASSUS AVE RM U125
SAN FRANCISCO CA
94143
US

IV. Provider business mailing address

333 1ST ST STE A
SAN FRANCISCO CA
94105-2661
US

V. Phone/Fax

Practice location:
  • Phone: 415-514-4539
  • Fax:
Mailing address:
  • Phone: 415-840-0560
  • Fax:

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 State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number144546
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: