Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | A79473 | CA |
NPI | 1134243439 |
---|---|
Provider Name | Dr. Sudhir P Kakarla |
First Address | Bakersfield, CA 93301-1900 |
Second Address | Bakersfield, CA 93309-7012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 11/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A794730 | (05) | CA |
100503827 | (05) | NV |
601555900 | OWCP (01) | |
H85857 | (02) | |
P00060101 | RR RETIREMENT (01) |