Healthcare Provider Details

I. General information

NPI: 1518724244
Provider Name (Legal Business Name): TAKESHI NISHI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 6TH ST
BROOKLYN NY
11215-3609
US

IV. Provider business mailing address

3308 W MAIN ST APT 201
KALAMAZOO MI
49006-6011
US

V. Phone/Fax

Practice location:
  • Phone: 650-238-7869
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number351012
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: