Provider Demographics
NPI:1831393560
Name:KAVKA, AUDREY (MD)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:
Last Name:KAVKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 BOULEVARD WAY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-1526
Mailing Address - Country:US
Mailing Address - Phone:510-835-3501
Mailing Address - Fax:
Practice Address - Street 1:459 BOULEVARD WAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-1526
Practice Address - Country:US
Practice Address - Phone:510-835-3501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG346652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry