Provider Demographics
NPI:1790946408
Name:KAKIMOTO, AMY CHARLOTTE (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:CHARLOTTE
Last Name:KAKIMOTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 N EL CAMINO REAL
Mailing Address - Street 2:A306
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1328
Mailing Address - Country:US
Mailing Address - Phone:176-094-0118
Mailing Address - Fax:760-942-5319
Practice Address - Street 1:477 N EL CAMINO REAL
Practice Address - Street 2:A306
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1328
Practice Address - Country:US
Practice Address - Phone:760-942-0118
Practice Address - Fax:760-942-5319
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99824207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine