MEDICARE: MS. TOMOKO KAKUTANI L.AC, M.S.

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
1	171100000X	Acupuncturist	AC00002558	WA

General Provider Information

NPI Number	:	1619197753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TOMOKO KAKUTANI L.AC, M.S.

Provider Business Mailing Address
First Line	:	11515 26TH AVE NE APT 303
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-5339
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15650 NE 24TH ST STE C2
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98008-2460
Country	:	US
Telephone Number	:	206-353-5353
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2007
Last Update Date	:	07/08/2007

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