Provider Demographics
NPI:1366671794
Name:KIKUCHI, ROBIN S (MAOM, LICAC)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:S
Last Name:KIKUCHI
Suffix:
Gender:F
Credentials:MAOM, LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 SAINT MARYS ST # A
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-3753
Mailing Address - Country:US
Mailing Address - Phone:617-247-1801
Mailing Address - Fax:
Practice Address - Street 1:124 SAINT MARYS ST # A
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-3753
Practice Address - Country:US
Practice Address - Phone:617-247-1801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2013-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA241989171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist