Healthcare Provider Details

I. General information

NPI: 1326490475
Provider Name (Legal Business Name): SASAKI MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 HAMLINE AVE N STE 110
ROSEVILLE MN
55113-5009
US

IV. Provider business mailing address

777 RAYMOND AVE
SAINT PAUL MN
55114-1522
US

V. Phone/Fax

Practice location:
  • Phone: 651-447-3755
  • Fax:
Mailing address:
  • Phone: 651-447-3755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALANA KIM SASAKI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 651-447-3755