Healthcare Provider Details

I. General information

NPI: 1225119530
Provider Name (Legal Business Name): KAORI A SAKURAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 04/25/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BARNES WEST DR DIV IM GERIATRICS, STE 200
SAINT LOUIS MO
63141-6287
US

IV. Provider business mailing address

PO BOX 60352
SAINT LOUIS MO
63160-0352
US

V. Phone/Fax

Practice location:
  • Phone: 314-286-2700
  • Fax: 314-983-0155
Mailing address:
  • Phone: 314-286-2700
  • Fax: 314-983-0155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number113012
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number113012
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: