Basic Information
Provider Information
NPI: 1538484746
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SAKATA
FirstName: KNEWTON
MiddleName: KAZUNORI
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 873010
Address2:  
City: VANCOUVER
State: WA
PostalCode: 986873010
CountryCode: US
TelephoneNumber: 3608822778
FaxNumber:  
Practice Location
Address1: 700 NE 87TH AVE
Address2:  
City: VANCOUVER
State: WA
PostalCode: 986641913
CountryCode: US
TelephoneNumber: 3608822778
FaxNumber: 3606041727
Other Information
ProviderEnumerationDate: 03/30/2010
LastUpdateDate: 07/05/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RP1001XMD60631195WAY Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
207RC0200XMD60631195WAN Allopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine

No ID Information.


Home