Provider Demographics
NPI:1891991642
Name:FAKHRAIE, KEIKO SATO (DO)
Entity type:Individual
Prefix:
First Name:KEIKO
Middle Name:SATO
Last Name:FAKHRAIE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12361 W BOLA DR STE 109
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85378-9021
Mailing Address - Country:US
Mailing Address - Phone:623-227-1000
Mailing Address - Fax:623-227-2000
Practice Address - Street 1:2501 N STOCKTON HILL RD STE 108
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4140
Practice Address - Country:US
Practice Address - Phone:928-255-5050
Practice Address - Fax:888-571-5897
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005309207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine