Healthcare Provider Details

I. General information

NPI: 1215362132
Provider Name (Legal Business Name): SCOTT AKIRA SATO PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 S OTHELLO ST
SEATTLE WA
98118-3510
US

IV. Provider business mailing address

PO BOX 3007
SEATTLE WA
98114-3007
US

V. Phone/Fax

Practice location:
  • Phone: 206-788-3500
  • Fax: 206-788-3521
Mailing address:
  • Phone: 206-788-3650
  • Fax: 206-490-4011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60404884
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: