Healthcare Provider Details

I. General information

NPI: 1912968082
Provider Name (Legal Business Name): HENRY SHUNJU SAKAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 BLUERIDGE AVE SUITE 200
WHEATON MD
20902-4517
US

IV. Provider business mailing address

18440 CROWNSGATE CIR
GERMANTOWN MD
20874-4417
US

V. Phone/Fax

Practice location:
  • Phone: 301-933-6440
  • Fax:
Mailing address:
  • Phone: 301-528-5004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0051640
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: