MEDICARE: DR. JOYCE A KAKKIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	G48142	CA

General Provider Information

NPI Number	:	1083670640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOYCE A KAKKIS MD

Provider Business Mailing Address
First Line	:	6700 E PACIFIC COAST HWY STE 140
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-4213
Country	:	US
Telephone Number	:	562-799-1176
Fax Number	:	562-493-2823

Provider Business Practice Location Address
First Line	:	6700 E PACIFIC COAST HWY STE 140
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803
Country	:	US
Telephone Number	:	562-799-1176
Fax Number	:	562-493-2823

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2006
Last Update Date	:	09/25/2018

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