Provider Demographics
NPI:1467524546
Name:KAKU, ROY F (MD)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:F
Last Name:KAKU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1730 PRAIRIE CITY RD STE 120
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-9594
Practice Address - Country:US
Practice Address - Phone:916-351-4800
Practice Address - Fax:916-357-6194
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30385207UN0901X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0068232Medicaid
CAZZZ47673ZOtherBLUE SHIELD
CAZZZ47676ZOtherBLUE SHIELD
CA060050048OtherRAILROAD MEDICARE
CAGR0068231Medicaid
CAGR0068235Medicaid
CA00G303850Medicaid
CAGR0068230Medicaid
CAZZZ62306ZOtherBLUE SHIELD
CAGR0068233Medicaid
CAGR006823BMedicaid
CAZZZ47674ZOtherBLUE SHIELD
CAZZZ00968ZMedicare PIN
CAZZZ47673ZOtherBLUE SHIELD
CAZZZ62306ZOtherBLUE SHIELD
CAGR006823BMedicaid
CAGR0068233Medicaid
CAZZZ00967ZMedicare PIN
CAGR0068235Medicaid
CAGR0068231Medicaid