Provider Demographics
NPI:1467493536
Name:NAGAI, BRIAN KAORU (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:KAORU
Last Name:NAGAI
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 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:510-490-1222
Mailing Address - Fax:
Practice Address - Street 1:3200 KEARNEY ST.
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:510-490-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV122212085R0202X
CAA691062085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00223485OtherRAILROAD MEDICARE
CA00A691060Medicaid
NVP00661309OtherRAILROAD MEDICARE
CAP00223485OtherRAILROAD MEDICARE
CABU295VMedicare PIN
CABU295ZMedicare PIN
CA00A691065Medicare PIN
CA00A691063Medicare PIN
CA00A691060Medicaid
CA00A691066Medicare PIN
NVP00661309OtherRAILROAD MEDICARE