Provider Demographics
NPI:1902959323
Name:SAKONJU, AI (MD)
Entity Type:Individual
Prefix:DR
First Name:AI
Middle Name:
Last Name:SAKONJU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SUNY UPSTATE MEDICAL UNIVERSITY
Mailing Address - Street 2:750 EAST ADAMS STREET, DEPT. OF NEUROLOGY
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210
Mailing Address - Country:US
Mailing Address - Phone:315-464-5302
Mailing Address - Fax:315-464-7328
Practice Address - Street 1:100 MARIO CAPECCHI DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113-1103
Practice Address - Country:US
Practice Address - Phone:801-587-7575
Practice Address - Fax:801-662-5696
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP172362084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology