Provider Demographics
NPI:1275610313
Name:NISHIGAYA, WAYNE TORU (MD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:TORU
Last Name:NISHIGAYA
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 1:3010 W ORANGE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3169
Mailing Address - Country:US
Mailing Address - Phone:714-827-9700
Mailing Address - Fax:714-827-6191
Practice Address - Street 1:3010 W ORANGE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3169
Practice Address - Country:US
Practice Address - Phone:714-827-9700
Practice Address - Fax:714-827-6191
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC32497207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW3038Medicare ID - Type Unspecified
CAA34960Medicare UPIN