Provider Demographics
NPI:1700591708
Name:KAKUTA, AI
Entity type:Individual
Prefix:
First Name:AI
Middle Name:
Last Name:KAKUTA
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 1:137 HIGH COUNTRY TRL
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-3156
Mailing Address - Country:US
Mailing Address - Phone:213-218-7362
Mailing Address - Fax:
Practice Address - Street 1:5603 ARAPAHOE AVE STE 5
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1377
Practice Address - Country:US
Practice Address - Phone:213-218-7362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU2791171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist