MEDICARE: MIZUKI NAGAYAMA

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1548194426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIZUKI NAGAYAMA

Provider Business Mailing Address
First Line	:	5130 KLUMP AVE APT K303
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-5048
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5130 KLUMP AVE APT K303
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-5048
Country	:	US
Telephone Number	:	339-927-2774
Fax Number	:

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

Provider Enumeration Date	:	06/09/2026
Last Update Date	:	06/09/2026

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