Provider Demographics
NPI:1053382044
Name:KAKIMOTO, CHARLENE VIMALA (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:VIMALA
Last Name:KAKIMOTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:230 PROSPECT PL
Mailing Address - Street 2:STE. 260
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-1978
Mailing Address - Country:US
Mailing Address - Phone:619-437-1146
Mailing Address - Fax:619-437-1912
Practice Address - Street 1:230 PROSPECT PL
Practice Address - Street 2:STE. 260
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-1978
Practice Address - Country:US
Practice Address - Phone:619-437-1146
Practice Address - Fax:619-437-1146
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA82481207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology