Provider Demographics
NPI:1003310368
Name:LENORE S KAKITA MD LLC
Entity Type:Organization
Organization Name:LENORE S KAKITA MD LLC
Other - Org Name:SKINREHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:KAKITA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-601-7611
Mailing Address - Street 1:9360 W FLAMINGO RD STE 110-325
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-6410
Mailing Address - Country:US
Mailing Address - Phone:702-582-6633
Mailing Address - Fax:
Practice Address - Street 1:9360 W FLAMINGO RD STE 110-325
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-6410
Practice Address - Country:US
Practice Address - Phone:702-582-6633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty