Provider Demographics
NPI:1881791440
Name:KIKUMOTO, JOSEPH KEITH (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:KEITH
Last Name:KIKUMOTO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31401 RANCHO VIEJO RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1851
Mailing Address - Country:US
Mailing Address - Phone:949-443-3794
Mailing Address - Fax:949-443-3828
Practice Address - Street 1:31401 RANCHO VIEJO RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1851
Practice Address - Country:US
Practice Address - Phone:949-443-3794
Practice Address - Fax:949-443-3828
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8759 TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist