| Kenko Interventions | |
|
111 S Washington Ave Ste 202 Park Ridge IL 60068-4293 | |
| (872) 228-5326 | |
| Not Available |
| Full Name | Kenko Interventions |
|---|---|
| Speciality | Psychologist |
| Location | 111 S Washington Ave Ste 202, Park Ridge, Illinois |
| Authorized Official Name and Position | Kenneth Kikuchi (OWNER) |
| Authorized Official Contact | 8722285326 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kenko Interventions 111 S Washington Ave Ste 202 Park Ridge IL 60068-4293 Ph: (872) 228-5326 | Kenko Interventions 111 S Washington Ave Ste 202 Park Ridge IL 60068-4293 Ph: (872) 228-5326 |
| NPI Number | 1013620657 |
|---|---|
| Provider Enumeration Date | 12/28/2022 |
| Last Update Date | 03/22/2023 |
| Certification Date | 03/22/2023 |
| Medicare PECOS PAC ID | 2567834765 |
|---|---|
| Medicare Enrollment ID | O20230216002708 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013620657 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kenneth Kikuchi |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1831673862 PECOS PAC ID: 3476925678 Enrollment ID: I20230216002796 |
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