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General NPI Number Information
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NPI Number | 1831673862
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Entity Type | Individual
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Provider Name | KENNETH KIKUCHI PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 09/14/2018
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Last Update Date | 02/05/2023
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Provider Practice Location Address
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Address Line | 111 S WASHINGTON AVE STE 202
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City | PARK RIDGE
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State | IL
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Zip | 60068-4293
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Country | US
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Telephone | 872-228-5326
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Fax |
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Provider Business Mailing Address
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Address Line | 4828 FARGO AVE
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City | SKOKIE
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State | IL
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Zip | 60077-3345
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Country | US
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Telephone | 872-228-5326
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071009712
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License Number State | IL
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