Provider Demographics
NPI:1235124322
Name:NANKIN, SHELDON JAY (MD)
Entity Type:Individual
Prefix:
First Name:SHELDON
Middle Name:JAY
Last Name:NANKIN
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 1:1310 W STEWART DR
Mailing Address - Street 2:SUITE 504
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3854
Mailing Address - Country:US
Mailing Address - Phone:714-997-2020
Mailing Address - Fax:714-997-0322
Practice Address - Street 1:1310 W STEWART DR
Practice Address - Street 2:SUITE 504
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3854
Practice Address - Country:US
Practice Address - Phone:714-997-2020
Practice Address - Fax:714-997-0322
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG17825208000000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G178251Medicaid
CA00G178250Medicaid
CAG17825Medicare PIN
CA00G178251Medicaid