=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801152996
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KEVIN H SAKAI DDS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2012
-----------------------------------------------------
Last Update Date | 09/03/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20811 WA-410 E
-----------------------------------------------------
City | BONNEY LAKE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98391-9839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-200-2500
-----------------------------------------------------
Fax | 253-200-2503
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 311 RIVER RD
-----------------------------------------------------
City | PUYALLUP
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98371-4113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-200-2500
-----------------------------------------------------
Fax | 253-200-2503
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. KEVIN HIDEHISA SAKAI
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 253-200-2500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | DE00010783
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------