Provider Demographics
NPI:1326063769
Name:KAKU, JEFFERY HITOSHI (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:HITOSHI
Last Name:KAKU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 E CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-4105
Mailing Address - Country:US
Mailing Address - Phone:714-738-6902
Mailing Address - Fax:714-738-0296
Practice Address - Street 1:2001 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-4105
Practice Address - Country:US
Practice Address - Phone:714-738-6902
Practice Address - Fax:714-738-0296
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8963TL152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT 8963 TPLOtherOPTOMETRY LICENSE #
CASD0089630Medicaid
CASD0089630Medicaid
CAWOP8963EMedicare ID - Type UnspecifiedPPIN