Healthcare Provider Details

I. General information

NPI: 1326016114
Provider Name (Legal Business Name): MIKIO A NIHIRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19330 JESSE LN STE 100
RIVERSIDE CA
92508-5077
US

IV. Provider business mailing address

21160 VIA TEODOCIO
YORBA LINDA CA
92887-1819
US

V. Phone/Fax

Practice location:
  • Phone: 844-827-8000
  • Fax:
Mailing address:
  • Phone: 405-274-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number24796
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number24796
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: