Provider Demographics
NPI:1588176812
Name:KITAGAWA, YUICHI (PA-C)
Entity Type:Individual
Prefix:
First Name:YUICHI
Middle Name:
Last Name:KITAGAWA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 BURKESVILLE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728
Mailing Address - Country:US
Mailing Address - Phone:270-318-3399
Mailing Address - Fax:270-215-5527
Practice Address - Street 1:803 BURKSVILLE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728
Practice Address - Country:US
Practice Address - Phone:270-318-3399
Practice Address - Fax:270-215-5527
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC662207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine