MEDICARE: DR. AKI KAWAMOTO PH.D.

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	103TC0700X	Clinical Psychologist	PS016887	PA
2	103T00000X	Psychologist	PSY21208	CA
3	103T00000X	Psychologist	6301016586	MI

General Provider Information

NPI Number	:	1760561708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AKI KAWAMOTO PH.D.

Provider Business Mailing Address
First Line	:	1091 GREEN RD
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48105-2801
Country	:	US
Telephone Number	:	510-295-5692
Fax Number	:

Provider Business Practice Location Address
First Line	:	1091 GREEN RD
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48105-2801
Country	:	US
Telephone Number	:	510-295-5692
Fax Number	:

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	09/14/2024

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