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General NPI Number Information
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NPI Number | 1891991642
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Entity Type | Individual
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Provider Name | KEIKO SATO FAKHRAIE D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 2501 N STOCKTON HILL RD STE 108
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City | KINGMAN
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State | AZ
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Zip | 86401-4140
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Country | US
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Telephone | 928-255-5050
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Fax | 888-571-5897
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Provider Business Mailing Address
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Address Line | 12361 W BOLA DR STE 109
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City | SURPRISE
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State | AZ
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Zip | 85378-9021
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Country | US
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Telephone | 623-227-1000
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Fax | 623-227-2000
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 005309
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License Number State | AZ
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