Provider Demographics
NPI:1518285592
Name:KIKUCHI, CHRISTIAN K (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:K
Last Name:KIKUCHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 S BERETANIA ST STE 750
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1881
Mailing Address - Country:US
Mailing Address - Phone:808-686-4010
Mailing Address - Fax:
Practice Address - Street 1:1401 S BERETANIA ST STE 750
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1881
Practice Address - Country:US
Practice Address - Phone:808-686-4010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-14
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-18661207X00000X
PAMT197448390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery