Provider Demographics
NPI:1164708475
Name:KIKAWA, ROGER
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:
Last Name:KIKAWA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8891 ATLANTA AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-7119
Mailing Address - Country:US
Mailing Address - Phone:714-960-9640
Mailing Address - Fax:714-960-6507
Practice Address - Street 1:8891 ATLANTA AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-7119
Practice Address - Country:US
Practice Address - Phone:714-960-9640
Practice Address - Fax:714-960-6507
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29658183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist