=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043431216
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICHARD T. NISHIKAWA, D.D.S., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23560 MADISON STREET SUITE 202
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90505-4710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-530-6444
-----------------------------------------------------
Fax | 310-530-9890
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23560 MADISON STREET SUITE 202
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90505-4710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-530-6444
-----------------------------------------------------
Fax | 310-530-9890
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RICHARD TAMOTSU NISHIKAWA
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 310-530-6444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 27348
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------