Koki Kawaguchi, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

RT007484 Issued in PA

Practice address

2497 Harlansburg Rd
New Castle, PA 16101-9723

Phone

(724) 658-8940

NPI assigned

Jan 25, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1548374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628121600000",
    "number": "1639633514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 E WATER ST",
            "city": "SLIPPERY ROCK",
            "state": "PA",
            "postal_code": "160571150",
            "telephone_number": "724-290-5647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2497 HARLANSBURG RD",
            "city": "NEW CASTLE",
            "state": "PA",
            "postal_code": "161019723",
            "telephone_number": "724-658-8940"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Vineyard Cir Apt 224",
            "address_purpose": "LOCATION",
            "city": "Slippery Rock",
            "state": "PA",
            "postal_code": "160577305",
            "country_code": "US",
            "telephone_number": "724-290-5647",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KAWAGUCHI",
        "first_name": "KOKI",
        "credential": "LAT, ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-01-25",
        "last_updated": "2021-08-05",
        "certification_date": "2021-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "PA",
            "license": "RT007484",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in New Castle, PA
• Providers in New Castle, PA by specialty
• Athletic Trainer in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.