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NPI Code Detail

MEDICARE: ASHLEY KIMIKO IKEDA

MEDICARE: ASHLEY KIMIKO IKEDA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2106H00000XMarriage & Family Therapist120013CA

General Provider Information

NPI Number : 1003299926
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY KIMIKO IKEDA
Provider Business Mailing Address
First Line : 10 MOSS AVE APT 20
Second Line :
City : OAKLAND
State : CA
Zip : 94610-1300
Country : US
Telephone Number : 415-225-8783
Fax Number :
Provider Business Practice Location Address
First Line : 3010 COLBY ST STE 221
Second Line :
City : BERKELEY
State : CA
Zip : 94705-2056
Country : US
Telephone Number : 510-922-9757
Fax Number : 510-922-9514
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2015
Last Update Date : 09/30/2020

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Directions to “ ASHLEY KIMIKO IKEDA ” Practice Location

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