Provider Demographics
NPI:1326776626
Name:YAMAGUCHI, MOEGI
Entity Type:Individual
Prefix:
First Name:MOEGI
Middle Name:
Last Name:YAMAGUCHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4-4-12-504 MASAGO, MIHAMA-KU
Mailing Address - Street 2:
Mailing Address - City:CHIBA
Mailing Address - State:CHIBA
Mailing Address - Zip Code:261-0011
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4-4-12-504 MASAGO,
Practice Address - Street 2:MIHAMA-KU
Practice Address - City:CHIBA
Practice Address - State:CHIBA
Practice Address - Zip Code:261-0011
Practice Address - Country:JP
Practice Address - Phone:080-208-8980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-13
Last Update Date:2022-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer