Provider Demographics
NPI:1861364929
Name:ICHIKAWA, KAORU (PHD)
Entity type:Individual
Prefix:DR
First Name:KAORU
Middle Name:
Last Name:ICHIKAWA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 VIA ALAMITOS
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-1653
Mailing Address - Country:US
Mailing Address - Phone:310-910-4408
Mailing Address - Fax:
Practice Address - Street 1:2216 VIA ALAMITOS
Practice Address - Street 2:
Practice Address - City:PALOS VERDES ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-1653
Practice Address - Country:US
Practice Address - Phone:310-910-4408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical