Provider Demographics
NPI:1013620657
Name:KENKO INTERVENTIONS
Entity Type:Organization
Organization Name:KENKO INTERVENTIONS
Other - Org Name:KENKO INTERVENTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KIKUCHI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:872-228-5326
Mailing Address - Street 1:111 S WASHINGTON AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4293
Mailing Address - Country:US
Mailing Address - Phone:872-228-5326
Mailing Address - Fax:
Practice Address - Street 1:111 S WASHINGTON AVE STE 202
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4293
Practice Address - Country:US
Practice Address - Phone:872-228-5326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-28
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty