Provider Demographics
NPI:1023049673
Name:KIKUCHI, EDWIN KAZUO (MSW)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:KAZUO
Last Name:KIKUCHI
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 33
Mailing Address - Street 2:
Mailing Address - City:RUNNING SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92382-0033
Mailing Address - Country:US
Mailing Address - Phone:909-867-2122
Mailing Address - Fax:
Practice Address - Street 1:29099HOSPITAL ROAD
Practice Address - Street 2:SUITE 209
Practice Address - City:LAKE ARROWHEAD
Practice Address - State:CA
Practice Address - Zip Code:92352
Practice Address - Country:US
Practice Address - Phone:909-337-8219
Practice Address - Fax:909-337-8920
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS46951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical