Healthcare Provider Details

I. General information

NPI: 1043829625
Provider Name (Legal Business Name): SASAKI MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 UNIVERSITY AVE W
ST PAUL MN
55104
US

IV. Provider business mailing address

777 RAYMOND AVE
ST PAUL MN
55114
US

V. Phone/Fax

Practice location:
  • Phone: 651-447-3755
  • Fax: 651-444-8923
Mailing address:
  • Phone: 651-447-3755
  • Fax: 651-444-8923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ALANA K SASAKI
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: MD
Phone: 651-447-3755