=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770669483
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIJUN SAKAL, MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2006
-----------------------------------------------------
Last Update Date | 04/17/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14662 SKYWAY
-----------------------------------------------------
City | MAGALIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95954-9356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-873-1676
-----------------------------------------------------
Fax | 530-873-2643
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14662 SKYWAY
-----------------------------------------------------
City | MAGALIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95954-9356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-873-1676
-----------------------------------------------------
Fax | 530-873-2643
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DON SAKAL
-----------------------------------------------------
Credential | PA-C
-----------------------------------------------------
Telephone | 530-873-1676
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number | A79563
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------