Healthcare Provider Details

I. General information

NPI: 1316030968
Provider Name (Legal Business Name): NIKKEI PEDIATRIC MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E 3RD STREET SUITE 803
LOS ANGELES CA
90013-1646
US

IV. Provider business mailing address

420 E 3RD STREET SUITE 803
LOS ANGELES CA
90013-1646
US

V. Phone/Fax

Practice location:
  • Phone: 213-617-7073
  • Fax: 213-617-3132
Mailing address:
  • Phone: 213-617-7073
  • Fax: 213-617-3132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GEORGE ETSURO NAKASHIMA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 213-617-7073