MEDICARE: DR. KENT JIMI NOZAKI O.D.

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	152WC0802X	Corneal and Contact Management Optometrist	08111T	CA

General Provider Information

NPI Number	:	1124000567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENT JIMI NOZAKI O.D.

Provider Business Mailing Address
First Line	:	25429 NARBONNE AVE
Second Line	:
City	:	LOMITA
State	:	CA
Zip	:	90717-2125
Country	:	US
Telephone Number	:	310-326-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	25429 NARBONNE AVE
Second Line	:
City	:	LOMITA
State	:	CA
Zip	:	90717-2125
Country	:	US
Telephone Number	:	310-326-1200
Fax Number	:

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	07/08/2007

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