Provider Demographics
NPI:1902920481
Name:SASAKI, HIROSHI M (PHD)
Entity Type:Individual
Prefix:DR
First Name:HIROSHI
Middle Name:M
Last Name:SASAKI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:HIRO
Other - Middle Name:M
Other - Last Name:SASAKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3470 TROUSDALE PKWY
Mailing Address - Street 2:WPH 1005
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-4036
Mailing Address - Country:US
Mailing Address - Phone:562-756-6211
Mailing Address - Fax:
Practice Address - Street 1:110 W OCEAN BLVD
Practice Address - Street 2:SUITE 18
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4605
Practice Address - Country:US
Practice Address - Phone:562-999-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24153103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACH73830Medicare ID - Type UnspecifiedDMH PROVIDER NUMBER