Healthcare Provider Details

I. General information

NPI: 1063464089
Provider Name (Legal Business Name): BILAL RAFIC KAAKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 BROCKTON AVE STE 302-5
RIVERSIDE CA
92506-0102
US

IV. Provider business mailing address

20409 YORBA LINDA BLVD STE K2-305
YORBA LINDA CA
92886-3042
US

V. Phone/Fax

Practice location:
  • Phone: 951-900-1201
  • Fax:
Mailing address:
  • Phone: 319-830-8969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberA89191
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: