MEDICARE: ISHCORP ENTERPRISES

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	PT26444	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ64802Z	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1497776512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISHCORP ENTERPRISES

Provider Business Mailing Address
First Line	:	7451 WARNER AVE
Second Line	:	STE. A
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-5494
Country	:	US
Telephone Number	:	714-596-0700
Fax Number	:	714-596-0774

Provider Business Practice Location Address
First Line	:	7451 WARNER AVE
Second Line	:	STE. A
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-5494
Country	:	US
Telephone Number	:	714-596-0700
Fax Number	:	714-596-0774

Authorized Official
Title or Position	:	OWNER/PHYSICAL THERAPIST
Name	:	MR. DAVID K. ISHII
Credential	:	MPT
Telephone Number	:	714-596-0700

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	04/27/2018

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Directions to “ISHCORP ENTERPRISES ” Practice Location

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