Healthcare Provider Details

I. General information

NPI: 1972338341
Provider Name (Legal Business Name): KAYLA KUKAUA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 W 5TH ST
HANFORD CA
93230-5029
US

IV. Provider business mailing address

27450 WESTOVER WAY
VALENCIA CA
91354-1833
US

V. Phone/Fax

Practice location:
  • Phone: 800-713-8698
  • Fax:
Mailing address:
  • Phone: 661-219-1570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA67961
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: