Provider Demographics
NPI:1710559141
Name:NAKAMURA, SEAN
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:NAKAMURA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 ZANKER RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-2130
Mailing Address - Country:US
Mailing Address - Phone:408-468-0100
Mailing Address - Fax:
Practice Address - Street 1:921 S 1ST ST STE B
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110-3126
Practice Address - Country:US
Practice Address - Phone:408-938-6731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist