Provider Demographics
NPI:1467957373
Name:IMAZAKI, YOSHIKI
Entity Type:Individual
Prefix:
First Name:YOSHIKI
Middle Name:
Last Name:IMAZAKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 N 92ND AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-5942
Mailing Address - Country:US
Mailing Address - Phone:402-812-2501
Mailing Address - Fax:
Practice Address - Street 1:6001 DODGE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68182-1102
Practice Address - Country:US
Practice Address - Phone:402-554-2057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-24
Last Update Date:2018-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program