MEDICARE: KEVIN NAKAYAMA DPT

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	225100000X	Physical Therapist	43638	CA

General Provider Information

NPI Number	:	1205397536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN NAKAYAMA DPT

Provider Business Mailing Address
First Line	:	30837 E THOUSAND OAKS BLVD
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91362-4039
Country	:	US
Telephone Number	:	818-879-2091
Fax Number	:

Provider Business Practice Location Address
First Line	:	12424 WILSHIRE BLVD FL 1
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1052
Country	:	US
Telephone Number	:	310-826-2977
Fax Number	:	310-826-2977

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

Provider Enumeration Date	:	03/28/2019
Last Update Date	:	03/28/2019

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