Provider Demographics
NPI:1790471365
Name:IKENO, YUKI
Entity Type:Individual
Prefix:
First Name:YUKI
Middle Name:
Last Name:IKENO
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 1:2-1 MONZEN
Mailing Address - Street 2:
Mailing Address - City:OBAMA
Mailing Address - State:FUKUI
Mailing Address - Zip Code:9170237
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6400 FANNIN ST STE 2850
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1540
Practice Address - Country:US
Practice Address - Phone:713-486-5183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer