Healthcare Provider Details

I. General information

NPI: 1013783455
Provider Name (Legal Business Name): YUSUKE OKADA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 11/28/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2922 NETWORK PL APT 201A
LUTZ FL
33559-2122
US

IV. Provider business mailing address

2922 NETWORK PL APT 201A
LUTZ FL
33559-2122
US

V. Phone/Fax

Practice location:
  • Phone: 620-636-1348
  • Fax:
Mailing address:
  • Phone: 620-636-1348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: