Provider Demographics
NPI:1548272198
Name:LAKIN, CHARLES M (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:M
Last Name:LAKIN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:200 W ARBOR DRIVE
Mailing Address - Street 2:MAILCODE 8897
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-8897
Mailing Address - Country:US
Mailing Address - Phone:619-543-3573
Mailing Address - Fax:619-543-3475
Practice Address - Street 1:200 W ARBOR DRIVE
Practice Address - Street 2:MEDICAL OFFICES NORTH SUITE 3-4
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-8706
Practice Address - Country:US
Practice Address - Phone:619-543-3572
Practice Address - Fax:619-543-3475
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2010-11-16
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Provider Licenses
StateLicense IDTaxonomies
CAG38869208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G388690Medicaid
CAC47616Medicare UPIN
CA00G388690Medicaid