Healthcare Provider Details

I. General information

NPI: 1487991741
Provider Name (Legal Business Name): YOKO JINGI ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 S GRAND AVE.
PULLMAN WA
99163
US

IV. Provider business mailing address

1605 NE VALLEY RD APT2
PULLMAN WA
99163
US

V. Phone/Fax

Practice location:
  • Phone: 509-338-9204
  • Fax:
Mailing address:
  • Phone: 509-251-5303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberA1 60249257
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: