Healthcare Provider Details

I. General information

NPI: 1649978354
Provider Name (Legal Business Name): SATO GENERAL & COSMETIC DERMATOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N KUAKINI ST STE 309
HONOLULU HI
96817-2360
US

IV. Provider business mailing address

321 N KUAKINI ST STE 309
HONOLULU HI
96817-2360
US

V. Phone/Fax

Practice location:
  • Phone: 808-585-9222
  • Fax: 808-585-2498
Mailing address:
  • Phone: 808-585-9222
  • Fax: 808-585-2498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHELSI NAOMI SATO
Title or Position: PRACTICE MANAGER
Credential:
Phone: 808-585-9222