Ryunosuke Hisatomi
Student in an Organized Health Care Education/Training Program in Shreveport, LA. Individual provider (NPI-1).
Details
- NPI
- 1316628217
- Entity type
- Individual (NPI-1)
- Name
- Ryunosuke Hisatomi
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jul 25, 2023
- Certification date
- Jul 25, 2023
- Last updated
- Jul 25, 2023
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · ORDER AND REFERRING ONLY - FAMILY PRACTICE
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | Yes |
Practice location
1501 Kings HwyShreveport, LA 71103-4228
Phone 318-626-4092
Mailing address
1501 Kings HwyShreveport, LA 71103-4228
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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