Provider Demographics
NPI:1508030727
Name:JOSEPH K. KIKUMOTO, O.D.
Entity Type:Organization
Organization Name:JOSEPH K. KIKUMOTO, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:KIKUMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:949-443-3794
Mailing Address - Street 1:31401 RANCHO VIEJO RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1851
Mailing Address - Country:US
Mailing Address - Phone:949-443-3794
Mailing Address - Fax:
Practice Address - Street 1:31401 RANCHO VIEJO RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1851
Practice Address - Country:US
Practice Address - Phone:949-443-3794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8759TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty