Provider Demographics
NPI:1710361522
Name:AKIYOSHI, SHINTARO
Entity Type:Individual
Prefix:
First Name:SHINTARO
Middle Name:
Last Name:AKIYOSHI
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 1:2-12-8 FUTSUKAICHI CHUO
Mailing Address - Street 2:
Mailing Address - City:CHIKUSHINO
Mailing Address - State:FUKUOKA
Mailing Address - Zip Code:8180072
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 E DESERT INN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-9398
Practice Address - Country:US
Practice Address - Phone:702-858-4467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker