Healthcare Provider Details

I. General information

NPI: 1699156281
Provider Name (Legal Business Name): NICHOLAS KENJI TAYLOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9925 INTERNATIONAL BLVD
OAKLAND CA
94603-2558
US

IV. Provider business mailing address

1944 108TH AVE
OAKLAND CA
94603-3912
US

V. Phone/Fax

Practice location:
  • Phone: 510-777-1177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA144643
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberM-2473
License Number StateGU
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM-2473
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: