Provider Demographics
NPI:1245290600
Name:STEVEN NISHIBAYASHI, MD, INC.
Entity type:Organization
Organization Name:STEVEN NISHIBAYASHI, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:NISHIBAYASHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-244-7237
Mailing Address - Street 1:110 W STOCKER ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2509
Mailing Address - Country:US
Mailing Address - Phone:818-244-7237
Mailing Address - Fax:818-244-6787
Practice Address - Street 1:110 W STOCKER ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2509
Practice Address - Country:US
Practice Address - Phone:818-244-7237
Practice Address - Fax:818-244-6787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38552261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service