Healthcare Provider Details

I. General information

NPI: 1326063769
Provider Name (Legal Business Name): JEFFERY HITOSHI KAKU O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 E CHAPMAN AVE
FULLERTON CA
92831-4105
US

IV. Provider business mailing address

2001 E CHAPMAN AVE
FULLERTON CA
92831-4105
US

V. Phone/Fax

Practice location:
  • Phone: 714-738-6902
  • Fax: 714-738-0296
Mailing address:
  • Phone: 714-738-6902
  • Fax: 714-738-0296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number8963TL
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number8963TL
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: