Provider Demographics
NPI:1184752974
Name:KAILIKOLE, THERESA L (DPM)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:L
Last Name:KAILIKOLE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 SACRAMENTO ST # 621
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1625
Mailing Address - Country:US
Mailing Address - Phone:415-600-4080
Mailing Address - Fax:415-600-4005
Practice Address - Street 1:3801 SACRAMENTO ST # 621
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1625
Practice Address - Country:US
Practice Address - Phone:415-600-4080
Practice Address - Fax:415-600-4005
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3612213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8191323Medicaid
CA000E36120Medicare ID - Type Unspecified
CA8191323Medicaid