Provider Demographics
NPI:1609040450
Name:NIHO, HENRY KOJI (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:KOJI
Last Name:NIHO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6650 ALTON PKWY
Mailing Address - Street 2:ALTON SAND CANYON MOB2
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3734
Mailing Address - Country:US
Mailing Address - Phone:949-932-2604
Mailing Address - Fax:
Practice Address - Street 1:6650 ALTON PKWY
Practice Address - Street 2:ALTON SAND CANYON MOB2
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3734
Practice Address - Country:US
Practice Address - Phone:949-932-2604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78576207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH92223Medicare UPIN