Provider Demographics
NPI:1417910241
Name:KIFUJI, KAYOKO (MD)
Entity Type:Individual
Prefix:DR
First Name:KAYOKO
Middle Name:
Last Name:KIFUJI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 TANNERY BROOK ROW
Mailing Address - Street 2:UNIT #1
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2756
Mailing Address - Country:US
Mailing Address - Phone:617-764-5068
Mailing Address - Fax:617-764-5068
Practice Address - Street 1:750 WASHINGTON ST
Practice Address - Street 2:BOX# 1007
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1526
Practice Address - Country:US
Practice Address - Phone:617-636-8877
Practice Address - Fax:617-636-8442
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA155248174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3199517Medicaid
MA3199517Medicaid
MAA30077Medicare ID - Type UnspecifiedM.D.