MEDICARE: YUJI ROBERT ITO C.P.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist
2	224P00000X	Prosthetist		NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	674650001	OTHER	NC	PTAN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710009519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YUJI ROBERT ITO C.P.O.

Provider Business Mailing Address
First Line	:	814 E 34TH ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-1571
Country	:	US
Telephone Number	:	704-957-5375
Fax Number	:

Provider Business Practice Location Address
First Line	:	1420 ELLEN ST
Second Line	:
City	:	MONROE
State	:	NC
Zip	:	28112-5173
Country	:	US
Telephone Number	:	704-635-7029
Fax Number	:	704-635-7495

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	10/04/2019

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