Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | SL0878 | NV |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | DO2388 | NV |
NPI | 1386904605 |
---|---|
Provider Name | Steven Keita Nishiyama |
First Address | Las Vegas, NV 89121-3609 |
Second Address | Las Vegas, NV 89121-3609 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2012 |
Last Update Date | 27/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DO2388 | NV MEDICAL LICENSE (01) | NV |