Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223E0200X | Endodontist | 058366 | NY |
Y | 1223E0200X | Endodontist | D10954 | OR |
N | 1223E0200X | Endodontist | DS030484L | PA |
NPI | 1063484525 |
---|---|
Provider Name | Dr. Koichi Saito |
First Address | Hillsboro, OR 97124-5611 |
Second Address | Portland, OR 97266-4661 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 03/01/2019 |