Provider Demographics
NPI:1972600344
Name:NISHI, GREGG K (MD)
Entity type:Individual
Prefix:DR
First Name:GREGG
Middle Name:K
Last Name:NISHI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:9033 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1837
Mailing Address - Country:US
Mailing Address - Phone:310-858-1242
Mailing Address - Fax:310-858-1172
Practice Address - Street 1:9033 WILSHIRE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1837
Practice Address - Country:US
Practice Address - Phone:310-858-1242
Practice Address - Fax:310-858-1172
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-07-21
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Provider Licenses
StateLicense IDTaxonomies
UT13342087-1205208600000X
AZ63430208600000X, 207RC0200X
CAA75418208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI29280Medicare UPIN