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: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22722 29TH DR SE STE 100
BOTHELL WA
98021-4420
US

IV. Provider business mailing address

522 CHALET CT
SAINT LOUIS MO
63141-7668
US

V. Phone/Fax

Practice location:
  • Phone: 888-651-3618
  • Fax:
Mailing address:
  • Phone: 314-397-2395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number113012
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: