Active NPI
Kenneth K Nakamoto, M.D.
- Emergency Medicine Physician
- Pomona, CA
National Provider Identifier
1215949102
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- G34422
- Practice address
- 1798 N Garey Ave
Pomona, CA 91767-2918 - Phone
- (909) 865-9600
- NPI assigned
- Aug 12, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | G34422 | CA | Primary |
Addresses
Primary practice location
1798 N Garey Ave
Pomona, CA 91767-2918
Mailing address
2100 Powell St
Suite 900
Emeryville, CA 94608-1826
Phone (510) 350-2600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G344220 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G34422 | CA | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cep America-California | Emergency Medicine | Current | Accepting new patients |
| Cep America - California | Emergency Medicine | Current | Accepting new patients |
| Cep America - California | Emergency Medicine | Current | Accepting new patients |
Locations
751 Medical Center Ct
#1182
Chula Vista, CA 91911
2100 Powell St
Ste 900
Emeryville, CA 94608
Phone (510) 350-2777
1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423
1798 N Garey Ave
Pomona, CA 91767
Phone (909) 865-9810
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Emergency Medicine Physician
- Santa Ana, CA
- NPI 1548667843
-
- Emergency Medicine Physician
- Pomona, CA
- NPI 1740235258
-
- Emergency Medicine Physician
- Murrieta, CA
- NPI 1588552848
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155340800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193356800000",
"number": "1215949102",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2100 POWELL ST",
"address_2": "SUITE 900",
"city": "EMERYVILLE",
"state": "CA",
"postal_code": "946081826",
"telephone_number": "510-350-2600",
"fax_number": "510-879-9100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1798 N GAREY AVE",
"city": "POMONA",
"state": "CA",
"postal_code": "917672918",
"telephone_number": "909-865-9600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NAKAMOTO",
"first_name": "KENNETH",
"middle_name": "K",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-12",
"last_updated": "2007-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "CA",
"license": "G34422",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G344220",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Pomona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.