Provider Demographics
NPI:1598336778
Name:ISHIKAWA, KORAN
Entity Type:Individual
Prefix:MS
First Name:KORAN
Middle Name:
Last Name:ISHIKAWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W WASHINGTON AVE UNIT 302
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-7063
Mailing Address - Country:US
Mailing Address - Phone:408-786-6168
Mailing Address - Fax:
Practice Address - Street 1:320 W WASHINGTON AVE UNIT 302
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-7063
Practice Address - Country:US
Practice Address - Phone:408-786-6168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
19103171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist