Provider Demographics
NPI:1417349838
Name:IKEDA, HIKARI (LICAC)
Entity Type:Individual
Prefix:
First Name:HIKARI
Middle Name:
Last Name:IKEDA
Suffix:
Gender:F
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 CHARLESBANK RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1703
Mailing Address - Country:US
Mailing Address - Phone:985-869-0517
Mailing Address - Fax:
Practice Address - Street 1:81 CHARLESBANK RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1703
Practice Address - Country:US
Practice Address - Phone:985-869-0517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist