Healthcare Provider Details

I. General information

NPI: 1104264712
Provider Name (Legal Business Name): YUKI ANNAJEAN SUGIMOTO PHD, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 12/07/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 N MICHIGAN AVE STE 1100
CHICAGO IL
60611-2877
US

IV. Provider business mailing address

645 N MICHIGAN AVE STE 1100
CHICAGO IL
60611-2877
US

V. Phone/Fax

Practice location:
  • Phone: 315-251-5975
  • Fax:
Mailing address:
  • Phone: 315-251-5975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: