Healthcare Provider Details

I. General information

NPI: 1225250103
Provider Name (Legal Business Name): DAN K SAKAMOTO M D MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23609 HAWTHORNE BLVD STE A
TORRANCE CA
90505-6023
US

IV. Provider business mailing address

23609 HAWTHORNE BLVD STE A
TORRANCE CA
90505-6023
US

V. Phone/Fax

Practice location:
  • Phone: 310-378-7474
  • Fax: 310-378-5454
Mailing address:
  • Phone: 310-378-7474
  • Fax: 310-378-5454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG23249
License Number StateCA

VIII. Authorized Official

Name: PAULINE SETSUKO KAWACHI
Title or Position: OFFICE MANAGER
Credential:
Phone: 310-378-7474