Healthcare Provider Details

I. General information

NPI: 1528568318
Provider Name (Legal Business Name): JONATHAN SHINJI NAKAMINE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2018
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 N BELLFLOWER BLVD
LONG BEACH CA
90840-0004
US

IV. Provider business mailing address

1328 OAHU ST
WEST COVINA CA
91792-1443
US

V. Phone/Fax

Practice location:
  • Phone: 562-985-4111
  • Fax:
Mailing address:
  • Phone: 626-824-5884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: