Provider Demographics
NPI:1053370825
Name:KAJIOKA, KEITH DAVID (OD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:DAVID
Last Name:KAJIOKA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 SYLVAN AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-1500
Mailing Address - Country:US
Mailing Address - Phone:209-524-0100
Mailing Address - Fax:209-524-0596
Practice Address - Street 1:809 SYLVAN AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-1500
Practice Address - Country:US
Practice Address - Phone:209-524-0100
Practice Address - Fax:209-524-0596
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7974T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0079741Medicaid
CASD0079740Medicaid
CASD0079741Medicaid
CAT10628Medicare UPIN
CA0624160001Medicare NSC