=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841400728
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STERLING MOICHIRO NAKAMURA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2007
-----------------------------------------------------
Last Update Date | 02/09/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2500 GRANT RD
-----------------------------------------------------
City | MOUNTAIN VIEW
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94040-4302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-962-4928
-----------------------------------------------------
Fax | 650-204-6837
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 60579
-----------------------------------------------------
City | PALO ALTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94306-0579
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-962-4928
-----------------------------------------------------
Fax | 650-204-6837
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0015X
-----------------------------------------------------
Taxonomy Name | Psychosomatic Medicine Physician
-----------------------------------------------------
License Number | A90609
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------