MEDICARE: DR. NICOLE SAKAI D.D.S., M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223D0001X	Public Health Dentistry	63446	CA
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	26311	TX
3	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	63446	CA

General Provider Information

NPI Number	:	1528366143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE SAKAI D.D.S., M.S.

Provider Business Mailing Address
First Line	:	11340 W OLYMPIC BLVD STE 337
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1613
Country	:	US
Telephone Number	:	310-479-8900
Fax Number	:

Provider Business Practice Location Address
First Line	:	11340 W OLYMPIC BLVD STE 337
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1613
Country	:	US
Telephone Number	:	310-479-8900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2011
Last Update Date	:	05/17/2022

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