Kenneth Kikuchi, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071009712 Issued in IL

Practice address

111 S Washington Ave Ste 202
Park Ridge, IL 60068-4293

Phone

(872) 228-5326

NPI assigned

Sep 14, 2018

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Ken Kikuchi Other name

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2004

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kenko Interventions

  • Clinical Psychologist
  • Park Ridge, IL
  • NPI 1013620657
  Medicare reassignment NPD Authorized official
• Center for Psychology and Wellness, P.C.

  • Psychologist
  • Northbrook, IL
  • NPI 1194113357
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1536883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675555200000",
    "number": "1831673862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4828 FARGO AVE",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600773345",
            "telephone_number": "872-228-5326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S WASHINGTON AVE STE 202",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600684293",
            "telephone_number": "872-228-5326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIKUCHI",
        "first_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-09-14",
        "last_updated": "2023-02-05",
        "certification_date": "2023-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071009712",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KEN",
            "last_name": "KIKUCHI",
            "prefix": "DR.",
            "credential": "PSYD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Nora Zara Khani, LCPC
• Rahul Khapekar, D.O.
• Deana Lynn Khoshaba, PSY.D.
• Simur Khurana
• Nilofer Anwar Kidiwala, D.O.
• Mark E Kiley, DO
• Dasom Kim
• Hyo-Jin Kim, M.D.
• Jay A Kim, RPH
• Lisa Sunhee Kim, M.D.

• Clinical Psychologist in Park Ridge, IL
• Providers in Park Ridge, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.