Charlene V. Kakimoto, MD, Inc
Organization Active NPI Clinical & Laboratory Dermatological Immunology Physician · Coronado, CA
NPI 1083104012 · NPPES record last updated May 15, 2018
Key facts
- NPI
- 1083104012
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical & Laboratory Dermatological Immunology Physician 207NI0002X
- License
- A82481 (CA)
- Legal business name
- CHARLENE V. KAKIMOTO, MD, INC
- Practice address
- 230 Prospect PL Ste 260
Coronado, CA 92118-1987 - Phone
- (619) 437-1146
- Fax
- (619) 437-1912
- NPI assigned
- May 15, 2018
- Organization subpart
- No
Authorized official
- Name
- Sirena Ferguson
- Title
- Office Manager
- Phone
- (619) 437-1146
Corporate family (same tax ID) 1
Practitioners 3
-
Charlene Vimala Kakimoto, M.D.
-
Nathan S. Uebelhoer, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180702003354 | CA | Part B Supplier - Clinic/Group Practice | 4880940956 |
Receives reassigned benefits from 3 practitioners Practice locations: Coronado, CA |
National Provider Directory
- Tax ID family
- Charlene V Kakimoto MD Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical & Laboratory Dermatological Immunology Physician |
207NI0002X | A82481 | CA | Yes |
Addresses
Primary practice location
230 Prospect PL Ste 260
Coronado, CA 92118-1987
Mailing address
230 Prospect PL Ste 260
Coronado, CA 92118-1987
Phone (619) 437-1146
Other providers in Coronado, CA
- Gina L. Casian
- Denise Casinelli
- Daryl F Catherwood
- Cep America - Neurology PC
- Jay Michael Channick
- Charlene V. Kakimoto, MD, Inc
- Charlotte a. Lee, M.D., P.a.
- Alexis Guadalupe Chavez
- Byeng Yuen Choi
- Chris S. Pallia, MD, Apc
All providers in Coronado, CA · Clinical & Laboratory Dermatological Immunology Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 15, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.