Provider Demographics
NPI:1861683245
Name:NOMOTO, EDWARD KAZUHISA (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:KAZUHISA
Last Name:NOMOTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8436 W 3RD ST STE 800
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4100
Mailing Address - Country:US
Mailing Address - Phone:310-746-5918
Mailing Address - Fax:
Practice Address - Street 1:444 S SAN VICENTE BLVD STE 800
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4174
Practice Address - Country:US
Practice Address - Phone:310-423-9780
Practice Address - Fax:310-423-9780
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA102820207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program