Healthcare Provider Details

I. General information

NPI: 1275890022
Provider Name (Legal Business Name): NIHON CLINIC SD, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3762 CLAIREMONT DR
SAN DIEGO CA
92117-5916
US

IV. Provider business mailing address

3762 CLAIREMONT DR
SAN DIEGO CA
92117-5916
US

V. Phone/Fax

Practice location:
  • Phone: 858-560-8910
  • Fax: 858-560-8011
Mailing address:
  • Phone: 858-560-8910
  • Fax: 858-560-8011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AKIKO CHEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 858-560-8910