Healthcare Provider Details

I. General information

NPI: 1659831733
Provider Name (Legal Business Name): ALEXANDER KIKUCHI MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2019
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 BERRY ST LBBY 2
SAN FRANCISCO CA
94107-5705
US

IV. Provider business mailing address

3955 BIGELOW BLVD APT 905
PITTSBURGH PA
15213-1238
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-7359
  • Fax:
Mailing address:
  • Phone: 831-332-1794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number13214551-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: