Provider Demographics
NPI:1114378411
Name:OKUWA, HIDEYUKI (ATC)
Entity Type:Individual
Prefix:
First Name:HIDEYUKI
Middle Name:
Last Name:OKUWA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 GRAFF AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-3266
Mailing Address - Country:US
Mailing Address - Phone:713-899-9897
Mailing Address - Fax:
Practice Address - Street 1:6 PENNYFIELD AVE
Practice Address - Street 2:ATHLETICS
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-4127
Practice Address - Country:US
Practice Address - Phone:718-409-7240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2016-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT46542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX090702220OtherBOC