MEDICARE: BARNARD NAGAI DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	39850	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B3985002	OTHER	CA	DENTICAL

General Provider Information

NPI Number	:	1013079417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARNARD NAGAI DDS INC

Provider Business Mailing Address
First Line	:	6700 LAUREL CANYON BLVD
Second Line	:	SUITE 3
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606
Country	:	US
Telephone Number	:	818-764-5333
Fax Number	:	818-765-0887

Provider Business Practice Location Address
First Line	:	6700 LAUREL CANYON BLVD
Second Line	:	SUITE 3
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606
Country	:	US
Telephone Number	:	818-764-5333
Fax Number	:	818-765-0887

Authorized Official
Title or Position	:	OFFICER
Name	:	DR. BARNARD GOWICHI NAGAI
Credential	:	DDS
Telephone Number	:	818-764-5333

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	08/22/2020

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