Healthcare Provider Details

I. General information

NPI: 1235124322
Provider Name (Legal Business Name): SHELDON JAY NANKIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W STEWART DR SUITE 504
ORANGE CA
92868-3854
US

IV. Provider business mailing address

1310 W STEWART DR SUITE 504
ORANGE CA
92868-3854
US

V. Phone/Fax

Practice location:
  • Phone: 714-997-2020
  • Fax: 714-997-0322
Mailing address:
  • Phone: 714-997-2020
  • Fax: 714-997-0322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG17825
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG17825
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: