Provider Demographics
NPI:1356557060
Name:KAKKIS MEDICAL GROUP INC
Entity type:Organization
Organization Name:KAKKIS MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAKKIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-799-1176
Mailing Address - Street 1:6700 E PACIFIC COAST HWY STE 140
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-4213
Mailing Address - Country:US
Mailing Address - Phone:562-799-1176
Mailing Address - Fax:562-493-2823
Practice Address - Street 1:6700 E PACIFIC COAST HWY STE 140
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4213
Practice Address - Country:US
Practice Address - Phone:562-799-1176
Practice Address - Fax:562-493-2823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48227207RS0012X
CAG48142207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty