Kristyn Keiko Nishimoto

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

92499 Issued in CA

Practice address

9645 Arrow Route
BLDG. 5, Ste. a
Rancho Cucamonga, CA 91730

Phone

(909) 948-5747

NPI assigned

Mar 13, 2012

Last updated

Jun 25, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1331596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750809600000",
    "number": "1902171739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9645 ARROW ROUTE",
            "address_2": "BLDG. 5, STE. A",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "91730",
            "telephone_number": "909-948-9747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9645 ARROW ROUTE",
            "address_2": "BLDG. 5, STE. A",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "91730",
            "telephone_number": "909-948-5747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISHIMOTO",
        "first_name": "KRISTYN",
        "middle_name": "KEIKO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-13",
        "last_updated": "2025-06-25",
        "certification_date": "2025-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "92499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2025; 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.