Provider Demographics
NPI:1538968060
Name:NISHIMORI DENTAL CORPORATION
Entity type:Organization
Organization Name:NISHIMORI DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:YUTAKA
Authorized Official - Last Name:NISHIMORI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-793-6947
Mailing Address - Street 1:200 S EL MOLINO AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2985
Mailing Address - Country:US
Mailing Address - Phone:626-793-6947
Mailing Address - Fax:
Practice Address - Street 1:200 S EL MOLINO AVE STE 1
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2985
Practice Address - Country:US
Practice Address - Phone:626-793-6947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-08
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty