MEDICARE: DR. EDWARD KAZUHISA NOMOTO MD

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
2	207X00000X	Orthopaedic Surgery Physician	A102820	CA

General Provider Information

NPI Number	:	1861683245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD KAZUHISA NOMOTO MD

Provider Business Mailing Address
First Line	:	8436 W 3RD ST STE 800
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-4100
Country	:	US
Telephone Number	:	310-746-5918
Fax Number	:

Provider Business Practice Location Address
First Line	:	444 S SAN VICENTE BLVD STE 800
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-4174
Country	:	US
Telephone Number	:	310-423-9780
Fax Number	:	310-423-9780

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

Provider Enumeration Date	:	08/09/2007
Last Update Date	:	04/04/2018

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