Provider Demographics
NPI:1063626893
Name:NAKAMURA, LEAH Y (MD)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:Y
Last Name:NAKAMURA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23961 CALLE DE LA MAGDALENA STE 500
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-7622
Mailing Address - Country:US
Mailing Address - Phone:949-855-1011
Mailing Address - Fax:949-855-8710
Practice Address - Street 1:23961 CALLE DE LA MAGDALENA STE 500
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-7622
Practice Address - Country:US
Practice Address - Phone:949-855-1011
Practice Address - Fax:949-855-8710
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA120197208800000X, 2088F0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088F0040XAllopathic & Osteopathic PhysiciansUrologyUrogynecology and Reconstructive Pelvic Surgery
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA800190595Medicaid
CA1063626893Medicaid
AZZ125248Medicare PIN
CAGJ957ZMedicare PIN