Provider Demographics
NPI:1932690831
Name:DARYN T. NISHIKAWA, D.D.S., INC
Entity Type:Organization
Organization Name:DARYN T. NISHIKAWA, D.D.S., INC
Other - Org Name:DARYN T. NISHIKAWA, D.D.S., INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARYN
Authorized Official - Middle Name:
Authorized Official - Last Name:NISHIKAWA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-462-2468
Mailing Address - Street 1:3556 TORRANCE BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4891
Mailing Address - Country:US
Mailing Address - Phone:310-543-1655
Mailing Address - Fax:
Practice Address - Street 1:3556 TORRANCE BLVD STE C
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4891
Practice Address - Country:US
Practice Address - Phone:310-543-1655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60702261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental