Provider Demographics
NPI:1083104012
Name:CHARLENE V. KAKIMOTO, MD, INC
Entity Type:Organization
Organization Name:CHARLENE V. KAKIMOTO, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SIRENA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-437-1146
Mailing Address - Street 1:230 PROSPECT PL STE 260
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-1987
Mailing Address - Country:US
Mailing Address - Phone:619-437-1146
Mailing Address - Fax:619-437-1912
Practice Address - Street 1:230 PROSPECT PL STE 260
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-1987
Practice Address - Country:US
Practice Address - Phone:619-437-1146
Practice Address - Fax:619-437-1912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82481207NI0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological ImmunologyGroup - Single Specialty