Provider Demographics
NPI:1588706691
Name:KAJIKAWA, KENDRIC ROBERT (OD)
Entity type:Individual
Prefix:DR
First Name:KENDRIC
Middle Name:ROBERT
Last Name:KAJIKAWA
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 1:100 E HUNTINGTON DR
Mailing Address - Street 2:STE 102
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-1022
Mailing Address - Country:US
Mailing Address - Phone:626-281-1399
Mailing Address - Fax:
Practice Address - Street 1:145 E DUARTE RD STE D
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-6691
Practice Address - Country:US
Practice Address - Phone:626-446-5235
Practice Address - Fax:626-446-5255
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6473T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6473TOtherOPTOMETRY LICENSE
CA0648440001Medicare NSC
CAU24089Medicare UPIN
CAP00853254Medicare PIN
P00853254Medicare PIN
CABE767ZMedicare PIN