MEDICARE: DR. WAYNE TETSUO NAKAYAMA D.D.S.

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	1223G0001X	General Practice Dentistry	24841	CA

General Provider Information

NPI Number	:	1053391193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE TETSUO NAKAYAMA D.D.S.

Provider Business Mailing Address
First Line	:	4514 S CENTINELA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-6206
Country	:	US
Telephone Number	:	310-397-6719
Fax Number	:	310-397-2069

Provider Business Practice Location Address
First Line	:	4514 S CENTINELA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-6206
Country	:	US
Telephone Number	:	310-397-6719
Fax Number	:	310-397-2069

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	02/14/2012

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