Provider Demographics
NPI:1205120169
Name:KIMURA, YUKO (ATC)
Entity type:Individual
Prefix:
First Name:YUKO
Middle Name:
Last Name:KIMURA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:YUKO
Other - Middle Name:
Other - Last Name:KIMURA-KOENIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2001 CONCERT DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-8088
Mailing Address - Country:US
Mailing Address - Phone:757-648-5500
Mailing Address - Fax:757-468-1860
Practice Address - Street 1:2001 CONCERT DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-8088
Practice Address - Country:US
Practice Address - Phone:757-648-5500
Practice Address - Fax:757-468-1860
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0126000104174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist