Individual
DR. AI IKUNAGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
1518 WALNUT ST, SUITE 607, PHILADELPHIA, PA 19102-3419
(267) 918-1428
Mailing address
1518 WALNUT ST, SUITE 607, PHILADELPHIA, PA 19102-3419
(267) 918-1428
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS016968
PA
Other
Enumeration date
11/12/2011
Last updated
08/04/2014
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