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General NPI Number Information
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NPI Number | 1114378411
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Entity Type | Individual
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Provider Name | HIDEYUKI OKUWA ATC
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Gender | Male
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Dates
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Enumeration Date | 06/28/2016
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Last Update Date | 10/30/2016
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Provider Practice Location Address
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Address Line | 6 PENNYFIELD AVE ATHLETICS
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City | BRONX
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State | NY
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Zip | 10465-4127
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Country | US
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Telephone | 718-409-7240
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Fax |
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Provider Business Mailing Address
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Address Line | 286 GRAFF AVE APT 1
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City | BRONX
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State | NY
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Zip | 10465-3266
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Country | US
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Telephone | 713-899-9897
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT4654
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License Number State | TX
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