Provider Demographics
NPI:1245931112
Name:KAKA, HUSSAM LAITH NAFA (MD)
Entity type:Individual
Prefix:MR
First Name:HUSSAM
Middle Name:LAITH NAFA
Last Name:KAKA
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 1:453 QUARRY RD
Mailing Address - Street 2:DEPARTMENT OF RADIOLOGY
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1419
Mailing Address - Country:US
Mailing Address - Phone:650-736-6172
Mailing Address - Fax:
Practice Address - Street 1:453 QUARRY RD
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1419
Practice Address - Country:US
Practice Address - Phone:650-736-6172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1886352085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology