Healthcare Provider Details

I. General information

NPI: 1831526466
Provider Name (Legal Business Name): JANINE KEIKO KAKU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 11/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20103 LAKE CHABOT RD
CASTRO VALLEY CA
94546-5305
US

IV. Provider business mailing address

2637 SHADELANDS DR
WALNUT CREEK CA
94598-2512
US

V. Phone/Fax

Practice location:
  • Phone: 510-727-3015
  • Fax:
Mailing address:
  • Phone: 925-948-8143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number23688
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: