Provider Demographics
NPI:1760127872
Name:KENKODO ACUPUNCTURE AND MASSAGE LLC
Entity Type:Organization
Organization Name:KENKODO ACUPUNCTURE AND MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:PINO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:617-957-8141
Mailing Address - Street 1:735 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2110
Mailing Address - Country:US
Mailing Address - Phone:617-957-8141
Mailing Address - Fax:
Practice Address - Street 1:735 BROADWAY
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2110
Practice Address - Country:US
Practice Address - Phone:617-957-8141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center