Provider Demographics
NPI:1861534711
Name:NISHIMURA, MIDORI (MD)
Entity type:Individual
Prefix:
First Name:MIDORI
Middle Name:
Last Name:NISHIMURA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-3256
Mailing Address - Country:US
Mailing Address - Phone:408-293-5864
Mailing Address - Fax:669-220-6755
Practice Address - Street 1:280 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-3256
Practice Address - Country:US
Practice Address - Phone:408-293-5864
Practice Address - Fax:669-220-6755
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA061183207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ05315ZMedicare PIN