Provider Demographics
NPI:1639189418
Name:NISHIKAWA, LAURIE LEIGH (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:LEIGH
Last Name:NISHIKAWA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:LEIGH
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15651 E IMPERIAL HWY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638
Mailing Address - Country:US
Mailing Address - Phone:562-943-3794
Mailing Address - Fax:562-943-7227
Practice Address - Street 1:15651 E IMPERIAL HWY
Practice Address - Street 2:SUITE 204
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638
Practice Address - Country:US
Practice Address - Phone:562-943-3794
Practice Address - Fax:562-943-7227
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0365261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice