Provider Demographics
NPI:1477993517
Name:NISHIMURA, KYLE T (DMD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:T
Last Name:NISHIMURA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16610 TAYLOR CT
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-2237
Mailing Address - Country:US
Mailing Address - Phone:310-525-6996
Mailing Address - Fax:
Practice Address - Street 1:16610 TAYLOR CT
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-2237
Practice Address - Country:US
Practice Address - Phone:310-525-6996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62496122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist