Healthcare Provider Details

I. General information

NPI: 1477247039
Provider Name (Legal Business Name): PATRICK SAIKI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 PACIFIC AVE
STOCKTON CA
95211-0110
US

IV. Provider business mailing address

3608 CHATSWORTH CT
STOCKTON CA
95209-1563
US

V. Phone/Fax

Practice location:
  • Phone: 209-598-9682
  • Fax:
Mailing address:
  • Phone: 209-598-9682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number2000052584
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: