Provider Demographics
NPI:1770690505
Name:NAKANISHI, ALAN S (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:S
Last Name:NAKANISHI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1617 SAINT MARKS PLZ
Mailing Address - Street 2:SUITE D
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6423
Mailing Address - Country:US
Mailing Address - Phone:209-478-1797
Mailing Address - Fax:209-478-1224
Practice Address - Street 1:1617 SAINT MARKS PLZ
Practice Address - Street 2:SUITE D
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6423
Practice Address - Country:US
Practice Address - Phone:209-478-1797
Practice Address - Fax:209-478-1224
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2008-06-03
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Provider Licenses
StateLicense IDTaxonomies
CAG012131207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G121310Medicaid
CA00G121310Medicare PIN
CA00G121310Medicaid