Healthcare Provider Details

I. General information

NPI: 1205397536
Provider Name (Legal Business Name): KEVIN NAKAYAMA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12424 WILSHIRE BLVD FL 1
LOS ANGELES CA
90025-1052
US

IV. Provider business mailing address

30837 E THOUSAND OAKS BLVD
WESTLAKE VILLAGE CA
91362-4039
US

V. Phone/Fax

Practice location:
  • Phone: 310-826-2977
  • Fax: 310-826-2977
Mailing address:
  • Phone: 818-879-2091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number43638
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: