Provider Demographics
NPI:1467455279
Name:HIJIYA, NOBUKO (MD)
Entity Type:Individual
Prefix:DR
First Name:NOBUKO
Middle Name:
Last Name:HIJIYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ST. JUDE CHILDREN'S RESEARCH HOSPITAL
Mailing Address - Street 2:332 N LAUDERDALE ST., MS 0515
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-2794
Mailing Address - Country:US
Mailing Address - Phone:901-495-3006
Mailing Address - Fax:901-495-3842
Practice Address - Street 1:ST. JUDE CHILDREN'S RESEARCH HOSPITAL
Practice Address - Street 2:332 N LAUDERDALE ST., MS 0515
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-2794
Practice Address - Country:US
Practice Address - Phone:901-495-3006
Practice Address - Fax:901-495-3842
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-09
Deactivation Date:2006-04-03
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
TN358542080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3349564Medicaid
TNH18009Medicare UPIN