Healthcare Provider Details

I. General information

NPI: 1326682493
Provider Name (Legal Business Name): YOSHIHIRO KOJIMA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2019
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 W JOHN ROBERT BILL DR
JOHNSON CITY TN
37614
US

IV. Provider business mailing address

3008 S ROAN ST APT 10
JOHNSON CITY TN
37601-7663
US

V. Phone/Fax

Practice location:
  • Phone: 660-864-1857
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: