MEDICARE: DR. CHARLENE VIMALA KAKIMOTO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	A82481	CA

General Provider Information

NPI Number	:	1053382044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLENE VIMALA KAKIMOTO M.D.

Provider Business Mailing Address
First Line	:	230 PROSPECT PL
Second Line	:	STE. 260
City	:	CORONADO
State	:	CA
Zip	:	92118-1978
Country	:	US
Telephone Number	:	619-437-1146
Fax Number	:	619-437-1912

Provider Business Practice Location Address
First Line	:	230 PROSPECT PL
Second Line	:	STE. 260
City	:	CORONADO
State	:	CA
Zip	:	92118-1978
Country	:	US
Telephone Number	:	619-437-1146
Fax Number	:	619-437-1146

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	09/27/2013

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Directions to “ DR. CHARLENE VIMALA KAKIMOTO M.D.” Practice Location

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