Basic Information
Provider Information
NPI: 1407388622
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SAKSA
FirstName: DANE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
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OtherLastName:  
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Mailing Information
Address1: 5767 W CENTURY BLVD SUITE 400
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900955631
CountryCode: US
TelephoneNumber: 3103018707
FaxNumber: 3103018751
Practice Location
Address1: 757 WESTWOOD PLZ STE 3325
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900958358
CountryCode: US
TelephoneNumber: 3107944494
FaxNumber: 3102673899
Other Information
ProviderEnumerationDate: 03/28/2017
LastUpdateDate: 08/10/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/10/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XA159937CAY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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