Basic Information
| Provider Information | |||||||||
| NPI: | 1386820363 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ITO | ||||||||
| FirstName: | HIROHIKO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 DODDS AVE | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374043911 | ||||||||
| CountryCode: | JP | ||||||||
| TelephoneNumber: | 8667305619 | ||||||||
| FaxNumber: | 4236983622 | ||||||||
| Practice Location | |||||||||
| Address1: | 386 OOAZA TAKAHATA | ||||||||
| Address2: | |||||||||
| City: | TAKAHATA | ||||||||
| State: | YAMAGATA | ||||||||
| PostalCode: | 9920351 | ||||||||
| CountryCode: | JP | ||||||||
| TelephoneNumber: | 81238521500 | ||||||||
| FaxNumber: | 81238521515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2008 | ||||||||
| LastUpdateDate: | 01/10/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 35.077554 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 102095991-0001 | 05 | PA | MEDICAID | 2010543 | 01 | PA | HIGHMARK | OTHER |