Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | G78746 | CA |
NPI | 1023083888 |
---|---|
Provider Name | Carol Yukiko Nishikubo |
First Address | Santa Monica, CA 90404-2208 |
Second Address | Santa Monica, CA 90404-2103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 19/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BN4251980 | DEA NUMBER (01) | CA |
G66375 | (02) | CA |
G78746 | CALIFORNIA LICENSE (01) | CA |
G787460 | (05) | CA |
GR0085740 | (05) | CA |