Provider Demographics
NPI:1063464089
Name:KAAKI, BILAL RAFIC (MD)
Entity type:Individual
Prefix:
First Name:BILAL
Middle Name:RAFIC
Last Name:KAAKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:495 E RINCON ST STE 208
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-1379
Mailing Address - Country:US
Mailing Address - Phone:951-870-8253
Mailing Address - Fax:951-394-0685
Practice Address - Street 1:6926 BROCKTON AVE STE 4
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3804
Practice Address - Country:US
Practice Address - Phone:844-400-2236
Practice Address - Fax:951-382-4111
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89191207V00000X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0484113Medicaid
IA10717OtherWELLMARK/DALE STREET
IA10767OtherWELLMARK/GRUNDY
IA1484113Medicaid
IA10751OtherWELLMARK/8TH STREET
IA10760OtherWELLMARK/VOLD
IA3484113Medicaid
IA2484113Medicaid
IA10767OtherWELLMARK/GRUNDY
IAI51243Medicare UPIN