Healthcare Provider Details

I. General information

NPI: 1366192502
Provider Name (Legal Business Name): SANAE SOPHIA OGURA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 IRVINE BLVD
TUSTIN CA
92780-3526
US

IV. Provider business mailing address

1095 IRVINE BLVD
TUSTIN CA
92780-3526
US

V. Phone/Fax

Practice location:
  • Phone: 714-505-7110
  • Fax: 714-505-7108
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA200567
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: