Healthcare Provider Details

I. General information

NPI: 1326101445
Provider Name (Legal Business Name): KAREN K.W. KAKISHIBA, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 RICHLAND RD
YUBA CITY CA
95991-6200
US

IV. Provider business mailing address

810 RICHLAND RD
YUBA CITY CA
95991-6200
US

V. Phone/Fax

Practice location:
  • Phone: 530-755-0464
  • Fax: 530-751-8514
Mailing address:
  • Phone: 530-755-0464
  • Fax: 530-751-8514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License NumberG56087
License Number StateCA

VIII. Authorized Official

Name: DR. KAREN K KAKISHIBA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 530-755-0464