Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | G48142 | CA |
NPI | 1083670640 |
---|---|
Provider Name | Dr. Joyce A Kakkis |
First Address | Long Beach, CA 90803-4213 |
Second Address | Long Beach, CA 90803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2006 |
Last Update Date | 25/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A92790 | (02) |