Provider Demographics
NPI:1902058670
Name:JANE KAKKIS, MD, INC.
Entity Type:Organization
Organization Name:JANE KAKKIS, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:LILIAN
Authorized Official - Last Name:KAKKIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:714-378-5011
Mailing Address - Street 1:9900 TALBERT AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5153
Mailing Address - Country:US
Mailing Address - Phone:714-378-5011
Mailing Address - Fax:714-378-5051
Practice Address - Street 1:9900 TALBERT AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5153
Practice Address - Country:US
Practice Address - Phone:714-378-5011
Practice Address - Fax:714-378-5051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53546174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty