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General NPI Number Information
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NPI Number | 1003310368
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Entity Type | Organization
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Legal Business Name | LENORE S KAKITA MD LLC
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Dates
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Enumeration Date | 03/21/2018
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Last Update Date | 03/21/2018
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Provider Practice Location Address
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Address Line | 9360 W FLAMINGO RD STE 110-325
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City | LAS VEGAS
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State | NV
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Zip | 89147-6410
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Country | US
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Telephone | 702-582-6633
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Fax |
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Provider Business Mailing Address
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Address Line | 9360 W FLAMINGO RD STE 110-325
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City | LAS VEGAS
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State | NV
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Zip | 89147-6410
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Country | US
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Telephone | 702-582-6633
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GRANT KAKITA
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Credential |
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Telephone | 818-601-7611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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