Healthcare Provider Details

I. General information

NPI: 1669992137
Provider Name (Legal Business Name): AYOOSH KAKKAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: AYOOSH KAKKAR MD

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 N PACIFIC COAST HWY STE 2060
EL SEGUNDO CA
90245-4401
US

IV. Provider business mailing address

3835 N FREEWAY BLVD STE 100
SACRAMENTO CA
95834-1954
US

V. Phone/Fax

Practice location:
  • Phone: 855-501-1004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA170029
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number009629
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: