Individual
JULIE S KIKUCHI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
121 E FORT ST, BOISE, ID 83712-6322
(208) 514-2525
(208) 375-2217
Mailing address
777 N RAYMOND ST, BOISE, ID 83704-9251
(208) 367-6030
(208) 367-6123
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
M-9466
ID
2080A0000X
Pediatric Adolescent Medicine Physician
M9466
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807362700
—
ID
Enumeration date
08/31/2006
Last updated
07/21/2022
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