Michelle R Kishimoto, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

11949T Issued in CA

Practice address

1815 Hawthorne Blvd
Ste 236 Galleria at South Bay
Redondo Beach, CA 90278-3424

Phone

(310) 370-1618

Fax

(310) 371-3126

NPI assigned

Jan 12, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1417007014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17868 HAZELWOOD CT",
            "city": "CARSON",
            "state": "CA",
            "postal_code": "907467481",
            "telephone_number": "310-886-0346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 HAWTHORNE BLVD",
            "address_2": "STE 236 GALLERIA AT SOUTH BAY",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902783424",
            "telephone_number": "310-370-1618",
            "fax_number": "310-371-3126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISHIMOTO",
        "first_name": "MICHELLE",
        "middle_name": "R",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "11949T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Redondo Beach, CA
• Providers in Redondo Beach, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.