Provider Demographics
NPI:1669422929
Name:KANEISHI, NELSON K (MD)
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:K
Last Name:KANEISHI
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 1:183 E 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2341
Mailing Address - Country:US
Mailing Address - Phone:530-891-6244
Mailing Address - Fax:530-891-0134
Practice Address - Street 1:183 E 8TH AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2341
Practice Address - Country:US
Practice Address - Phone:530-891-6244
Practice Address - Fax:530-891-0134
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72461207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G724610Medicaid
00G724610Medicare ID - Type Unspecified
CA00G724610Medicaid