Healthcare Provider Details

I. General information

NPI: 1790471365
Provider Name (Legal Business Name): YUKI IKENO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 FANNIN ST STE 2850
HOUSTON TX
77030-1540
US

IV. Provider business mailing address

2-1 MONZEN
OBAMA FUKUI
9170237
JP

V. Phone/Fax

Practice location:
  • Phone: 713-486-5183
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberW1172
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: