Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 59368 | CA |
NPI | 1104145044 |
---|---|
Provider Name | Dr. Camille Thuy Nishikawa |
First Address | Los Angeles, CA 90089-0093 |
Second Address | Los Angeles, CA 90089-0093 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2010 |
Last Update Date | 22/08/2016 |