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NPI Code Detail

MEDICARE: STEVEN NISHIBAYASHI, MD, INC.

MEDICARE: STEVEN NISHIBAYASHI, MD, 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
1261QH0100XHealth Service Clinic/CenterG38552CA

General Provider Information

NPI Number : 1245290600
Entity Type Code : Organization
Provider Name (Legal Business Name) : STEVEN NISHIBAYASHI, MD, INC.
Provider Business Mailing Address
First Line : 110 W STOCKER ST
Second Line :
City : GLENDALE
State : CA
Zip : 91202-2509
Country : US
Telephone Number : 818-244-7237
Fax Number : 818-244-6787
Provider Business Practice Location Address
First Line : 110 W STOCKER ST
Second Line :
City : GLENDALE
State : CA
Zip : 91202-2509
Country : US
Telephone Number : 818-244-7237
Fax Number : 818-244-6787
Authorized Official
Title or Position : PRESIDENT
Name : DR. STEVEN WAYNE NISHIBAYASHI
Credential :
Telephone Number : 818-244-7237
Provider Enumeration Date : 03/28/2006
Last Update Date : 08/22/2020

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