Provider Demographics
NPI:1053320242
Name:NISHIO, ANGELA YAT-SUN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:YAT-SUN
Last Name:NISHIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:NISHIO
Other - Last Name:TY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1301 20TH ST
Mailing Address - Street 2:SUITE 270
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2050
Mailing Address - Country:US
Mailing Address - Phone:310-828-8585
Mailing Address - Fax:310-453-4844
Practice Address - Street 1:1301 20TH ST STE 270
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2053
Practice Address - Country:US
Practice Address - Phone:310-828-8585
Practice Address - Fax:310-453-4844
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA067519207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology