Provider Demographics
NPI:1598715427
Name:KAKKIS, JANE L (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:L
Last Name:KAKKIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3857 BIRCH ST # 626
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2616
Mailing Address - Country:US
Mailing Address - Phone:714-378-5043
Mailing Address - Fax:949-258-5287
Practice Address - Street 1:9900 TALBERT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5153
Practice Address - Country:US
Practice Address - Phone:714-378-5011
Practice Address - Fax:714-378-5051
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA535462086X0206X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH40624Medicare UPIN