Healthcare Provider Details

I. General information

NPI: 1558534552
Provider Name (Legal Business Name): NORMAN DENNIS KIKUCHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4156 MANZANITA AVE # 100
CARMICHAEL CA
95608-1726
US

IV. Provider business mailing address

245 MOUNT HERMON RD STE M
SCOTTS VALLEY CA
95066-4045
US

V. Phone/Fax

Practice location:
  • Phone: 916-483-5400
  • Fax: 916-483-1937
Mailing address:
  • Phone: 831-459-9424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberG39532
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: