Healthcare Provider Details

I. General information

NPI: 1144831900
Provider Name (Legal Business Name): AIRIN KAKU FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10455 S DE ANZA BLVD
CUPERTINO CA
95014-3011
US

IV. Provider business mailing address

10455 S DE ANZA BLVD
CUPERTINO CA
95014-3011
US

V. Phone/Fax

Practice location:
  • Phone: 408-996-1911
  • Fax:
Mailing address:
  • Phone: 408-996-1911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95013995
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95158484
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: