Basic Information
| Provider Information | |||||||||
| NPI: | 1720316490 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HATANAKA | ||||||||
| FirstName: | YUKIKO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 PARKMOOR AVE STE 210 | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951263798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4089619849 | ||||||||
| FaxNumber: | 4089619856 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 PARKMOOR AVE STE 210 | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951263798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4089619849 | ||||||||
| FaxNumber: | 4089619856 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2009 | ||||||||
| LastUpdateDate: | 03/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 106H00000X | 112486 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.