Provider Demographics
NPI:1669676284
Name:ICHIKAWA, MASAHIRO
Entity Type:Individual
Prefix:
First Name:MASAHIRO
Middle Name:
Last Name:ICHIKAWA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 B ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-1903
Mailing Address - Country:US
Mailing Address - Phone:617-484-8878
Mailing Address - Fax:
Practice Address - Street 1:25 CHURCH ST
Practice Address - Street 2:#4
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-3855
Practice Address - Country:US
Practice Address - Phone:617-926-6986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220798171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist