Provider Demographics
NPI:1194767830
Name:NAGOSHI, MAKOTO (MD)
Entity type:Individual
Prefix:
First Name:MAKOTO
Middle Name:
Last Name:NAGOSHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6430 W SUNSET BLVD
Mailing Address - Street 2:ANESTHESIOLOGY, CHILDREN'S HOSPITAL LOS ANGELES
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-7901
Mailing Address - Country:US
Mailing Address - Phone:323-361-2797
Mailing Address - Fax:
Practice Address - Street 1:6450 SUNSET BLVD
Practice Address - Street 2:ANESTHESIOLOGY, CHILDREN'S HOSPITAL LOS ANGELES
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028
Practice Address - Country:US
Practice Address - Phone:323-361-2797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83667207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A836670303OtherCALOPTIMA
NV100506003Medicaid
CA00A836670OtherBLUE SHIELD OF CA
CAP00249111OtherRR MEDICARE
CA00A836670Medicaid
H90954Medicare UPIN
CA00A836670Medicaid