Healthcare Provider Details

I. General information

NPI: 1972600344
Provider Name (Legal Business Name): GREGG K NISHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9033 WILSHIRE BLVD SUITE 200
BEVERLY HILLS CA
90211-1837
US

IV. Provider business mailing address

9033 WILSHIRE BLVD SUITE 200
BEVERLY HILLS CA
90211-1837
US

V. Phone/Fax

Practice location:
  • Phone: 310-858-1242
  • Fax: 310-858-1172
Mailing address:
  • Phone: 310-858-1242
  • Fax: 310-858-1172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number63430
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number13342087-1205
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number63430
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA75418
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: