Provider Demographics
NPI:1700508025
Name:YOSHIKAWA, KENTARO
Entity Type:Individual
Prefix:
First Name:KENTARO
Middle Name:
Last Name:YOSHIKAWA
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 1:765 W ADAMS ST APT 1611
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-3511
Mailing Address - Country:US
Mailing Address - Phone:773-584-8859
Mailing Address - Fax:
Practice Address - Street 1:765 W ADAMS ST APT 1611
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-3511
Practice Address - Country:US
Practice Address - Phone:773-584-8859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125081072204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery