Provider Demographics
NPI:1982211769
Name:KONISHI, MINAMI (NP)
Entity type:Individual
Prefix:MISS
First Name:MINAMI
Middle Name:
Last Name:KONISHI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N EUCLID ST STE 400
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-4132
Mailing Address - Country:US
Mailing Address - Phone:714-551-9720
Mailing Address - Fax:714-560-7678
Practice Address - Street 1:710 N EUCLID ST STE 203
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-4122
Practice Address - Country:US
Practice Address - Phone:714-551-9720
Practice Address - Fax:714-560-7678
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-3049363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care