Healthcare Provider Details

I. General information

NPI: 1629996137
Provider Name (Legal Business Name): JORDAN ARTHUR NAKANO PERRY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5889 W 74TH ST
LOS ANGELES CA
90045-1721
US

IV. Provider business mailing address

5889 W 74TH ST
LOS ANGELES CA
90045-1721
US

V. Phone/Fax

Practice location:
  • Phone: 310-692-0740
  • Fax:
Mailing address:
  • Phone: 310-692-0740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number29300
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: