The highway connects Tokyo and Aomori via Utsunomiya, Kōriyama, Sendai, and Morioka.

[2] The southern terminus of National Route 4 lies at Nihonbashi, the kilometer zero of Japan in Chūō, Tokyo.

[4] National Route 4 travels north through Adachi, roughly paralleling the Tobu Skytree Line.

It then curves to the northwest, crossing over the Kena River into the city of Sōka in Saitama Prefecture.

They were established by Tokugawa Ieyasu for government officials traveling through the area to connect Edo (modern-day Tokyo) with Mutsu Province and the present-day city of Shirakawa, Fukushima Prefecture, Japan.

During the 2011 Great East Japan Earthquake many sections of the route in the Tōhoku area were damaged.