Provider Demographics
NPI:1356301469
Name:JEFF KAKU, O.D., INC.
Entity type:Organization
Organization Name:JEFF KAKU, O.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:HITOSHI
Authorized Official - Last Name:KAKU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-738-6902
Mailing Address - Street 1:2001 E CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-4105
Mailing Address - Country:US
Mailing Address - Phone:714-738-6902
Mailing Address - Fax:714-738-0296
Practice Address - Street 1:2001 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-4105
Practice Address - Country:US
Practice Address - Phone:714-738-6902
Practice Address - Fax:714-738-0296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8963TL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0089630Medicaid
CASD0089630Medicaid
CA5587630001Medicare NSC
CAMK1007637OtherDEA LICENSE
CASD0089630Medicaid