Provider Demographics
NPI:1770685752
Name:NOGUCHI, NELSON N (MD)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:N
Last Name:NOGUCHI
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 1:1211 W LA PALMA AVE STE 609
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-2813
Mailing Address - Country:US
Mailing Address - Phone:714-635-9347
Mailing Address - Fax:714-635-2970
Practice Address - Street 1:1211 W LA PALMA AVE STE 609
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2813
Practice Address - Country:US
Practice Address - Phone:714-635-9347
Practice Address - Fax:714-635-2970
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG45971207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G459710Medicaid
A50248Medicare UPIN
G45971Medicare ID - Type Unspecified
CA00G459710Medicaid