Provider Demographics
NPI:1952403909
Name:IKEDA, NAOKO (DO)
Entity Type:Individual
Prefix:
First Name:NAOKO
Middle Name:
Last Name:IKEDA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3903 LONE TREE WAY
Mailing Address - Street 2:104
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-6249
Mailing Address - Country:US
Mailing Address - Phone:925-755-1255
Mailing Address - Fax:925-755-1259
Practice Address - Street 1:3903 LONE TREE WAY
Practice Address - Street 2:104
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6249
Practice Address - Country:US
Practice Address - Phone:925-755-1255
Practice Address - Fax:925-755-1259
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002697207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I66631Medicare UPIN