Provider Demographics
NPI:1942839170
Name:KAKIZAKI, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:KAKIZAKI
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 1:492 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01051-1047
Mailing Address - Country:US
Mailing Address - Phone:508-832-6075
Mailing Address - Fax:508-832-9964
Practice Address - Street 1:492 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-5708
Practice Address - Country:US
Practice Address - Phone:508-832-6075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2540213E00000X
390200000X
MA1517213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program