Provider Demographics
NPI:1902856602
Name:HONDA, NATHAN S (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:S
Last Name:HONDA
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:PO BOX 511246
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-3045
Mailing Address - Country:US
Mailing Address - Phone:562-698-0811
Mailing Address - Fax:562-789-4355
Practice Address - Street 1:12401 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1006
Practice Address - Country:US
Practice Address - Phone:562-906-5500
Practice Address - Fax:562-789-6872
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC041628207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0048460Medicaid
CAGR0048460Medicaid
CAWC41628AMedicare PIN