Individual
YUJI ROBERT ITO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.P.O.
Contact information
Practice address
1420 ELLEN ST, MONROE, NC 28112-5173
(704) 635-7029
(704) 635-7495
Mailing address
814 E 34TH ST, CHARLOTTE, NC 28205-1571
(704) 957-5375
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
224P00000X
Prosthetist
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
674650001
PTAN
NC
05
—
7702811
—
NC
05
—
7795313
—
NC
Enumeration date
04/04/2007
Last updated
10/04/2019
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