Basic Information
| Provider Information | |||||||||
| NPI: | 1427147008 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRUMAN M. SASAKI, MD, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 23200 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972813200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033385353 | ||||||||
| FaxNumber: | 5033385252 | ||||||||
| Practice Location | |||||||||
| Address1: | 2055 EXCHANGE ST | ||||||||
| Address2: | SUITE 290 | ||||||||
| City: | ASTORIA | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971033419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033385353 | ||||||||
| FaxNumber: | 5033385252 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 12/09/2008 | ||||||||
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| AuthorizedOfficialLastName: | SASAKI | ||||||||
| AuthorizedOfficialFirstName: | TRUMAN | ||||||||
| AuthorizedOfficialMiddleName: | MAKOTO | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5033385353 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD09424 | OR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 856096000 | 01 | OR | REGENCE BC/BS | OTHER | 246397 | 05 | OR | MEDICAID | DD7060 | 01 | OR | RAILROAD MEDICARE | OTHER | L3053 01 | 01 | OR | PACIFICSOURCE HEALTH PLAN | OTHER | 1121193 | 05 | WA | MEDICAID | 0188115 | 01 | WA | DEPT LABOR & INDUSTRIES | OTHER |