Healthcare Provider Details

I. General information

NPI: 1720316490
Provider Name (Legal Business Name): YUKIKO HATANAKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2009
Last Update Date: 07/19/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 MALECH DR
SAN JOSE CA
95138-2004
US

IV. Provider business mailing address

9500 MALECH DR
SAN JOSE CA
95138-2004
US

V. Phone/Fax

Practice location:
  • Phone: 408-281-6542
  • Fax: 82-816-5804
Mailing address:
  • Phone: 408-281-6542
  • Fax: 408-281-3580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number112486
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: