Basic Information
| Provider Information | |||||||||
| NPI: | 1093758484 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SASAKI | ||||||||
| FirstName: | TRUMAN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 23200 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972813200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002618373 | ||||||||
| FaxNumber: | 5039684660 | ||||||||
| Practice Location | |||||||||
| Address1: | 2055 EXCHANGE ST | ||||||||
| Address2: | SUITE 290 | ||||||||
| City: | ASTORIA | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971033419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033385353 | ||||||||
| FaxNumber: | 5033385252 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 04/13/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD09424 | OR | Y | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MD00043729 | WA | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0129X | MD09424 | OR | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | MD00043729 | WA | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 856096000 | 01 | OR | REGENCE BC/BS | OTHER | 246397 | 05 | OR | MEDICAID | 0188115 | 01 | WA | DEPT OF L&I | OTHER | P00245484 | 01 | OR | RR MEDICARE | OTHER | 1121193 | 05 | WA | MEDICAID |