Provider Demographics
NPI:1295711208
Name:KIKUCHI, KERRY L (MD)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:L
Last Name:KIKUCHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 SEA CHANNEL DR
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586-1641
Mailing Address - Country:US
Mailing Address - Phone:281-326-7626
Mailing Address - Fax:
Practice Address - Street 1:500 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4220
Practice Address - Country:US
Practice Address - Phone:281-338-3110
Practice Address - Fax:281-338-3352
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8766207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167957301Medicaid
TX8G6286OtherBCBSTX PROV NO
TX167957302Medicaid
TXP00157181Medicare PIN
TX8C5987Medicare PIN
TX167957301Medicaid
TXP00157470Medicare PIN
TX8C5986Medicare PIN