Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 08111T | CA |
NPI | 1124000567 |
---|---|
Provider Name | Dr. Kent Jimi Nozaki |
First Address | Lomita, CA 90717-2125 |
Second Address | Lomita, CA 90717-2125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 08/07/2007 |