Provider Demographics
NPI:1376554261
Name:KAKAZU, CLINTON Z (MD)
Entity Type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:Z
Last Name:KAKAZU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1000 W CARSON ST
Mailing Address - Street 2:DEPT OF ANESTHESIOLOGY, BOX 10
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2004
Mailing Address - Country:US
Mailing Address - Phone:310-222-3472
Mailing Address - Fax:310-222-5477
Practice Address - Street 1:1000 W CARSON ST
Practice Address - Street 2:DEPT OF ANESTHESIOLOGY, BOX 10
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2004
Practice Address - Country:US
Practice Address - Phone:310-222-3477
Practice Address - Fax:310-222-5252
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIE07448207L00000X
CAA85510207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI566713-01Medicaid
HI566713-01Medicaid
HIH00854Medicare PIN