Provider Demographics
NPI:1740654607
Name:YAMAGUCHI, JONATHAN T
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:T
Last Name:YAMAGUCHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JON
Other - Middle Name:T
Other - Last Name:YAMAGUCHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:247 E CHESTNUT ST
Mailing Address - Street 2:APT #1503
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2429
Mailing Address - Country:US
Mailing Address - Phone:480-789-9960
Mailing Address - Fax:
Practice Address - Street 1:240 E HURON ST
Practice Address - Street 2:SUITE 1-200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2909
Practice Address - Country:US
Practice Address - Phone:312-503-7975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program