Provider Demographics
NPI:1477513125
Name:374TH MEDGRP-YOKOTA
Entity type:Organization
Organization Name:374TH MEDGRP-YOKOTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DHA UBO
Authorized Official - Prefix:
Authorized Official - First Name:JEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWANDOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-817-4030
Mailing Address - Street 1:UNIT 5225
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96328 5225
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UNIT 5225
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96328 5225
Practice Address - Country:JP
Practice Address - Phone:01181311-755-8302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:374TH MEDGRP-YOKOTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-27
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1101XAmbulatory Health Care FacilitiesClinic/CenterMilitary and U.S. Coast Guard Ambulatory Procedure