MEDICARE: DR. JASON BEN NISHIKUBO D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DT2601	HI
2	122300000X	Dentist	DT2601	HI

General Provider Information

NPI Number	:	1417330978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON BEN NISHIKUBO D.M.D.

Provider Business Mailing Address
First Line	:	72650 FRED WARING DR STE 107
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-5007
Country	:	US
Telephone Number	:	760-341-8414
Fax Number	:

Provider Business Practice Location Address
First Line	:	72650 FRED WARING DR STE 107
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-5007
Country	:	US
Telephone Number	:	760-341-8414
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2015
Last Update Date	:	12/30/2025

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Directions to “ DR. JASON BEN NISHIKUBO D.M.D.” Practice Location

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