Healthcare Provider Details

I. General information

NPI: 1851160394
Provider Name (Legal Business Name): YOSHIKI IWAYA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2023
Last Update Date: 12/26/2023
Certification Date: 12/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 SPRUCE ST APT 113
TERRE HAUTE IN
47807-5204
US

IV. Provider business mailing address

1051 SPRUCE ST APT 113
TERRE HAUTE IN
47807-5204
US

V. Phone/Fax

Practice location:
  • Phone: 812-262-4301
  • Fax:
Mailing address:
  • Phone: 812-262-4301
  • 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: