=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326593187
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YUKI YANO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2016
-----------------------------------------------------
Last Update Date | 08/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16-716 VOLCANO RD
-----------------------------------------------------
City | KEAAU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96749-8150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-982-0604
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 605 KAUMANA DR
-----------------------------------------------------
City | HILO
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96720-1814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | AT-45
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------