Provider Demographics
NPI:1669992137
Name:KAKKAR, AYOOSH (MD)
Entity type:Individual
Prefix:DR
First Name:AYOOSH
Middle Name:
Last Name:KAKKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:AYOOSH
Other - Middle Name:
Other - Last Name:KAKKAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:390 N PACIFIC COAST HWY STE 2060
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-4401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 SENECA ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-1411
Practice Address - Country:US
Practice Address - Phone:805-653-6434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0096292084P0800X
CAA1700292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry