DR. DEREK YUTAKA NISHIMORI D.D.S.
NPI 1164807012
Dentist - General Practice in San Jose, CA

Q: What is Derek Nishimori's NPI number?

The NPI number for Derek Nishimori is 1164807012. It was assigned to this individual provider in the NPPES registry on July 21, 2015.

Q: What is Derek Nishimori's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Q: When was this NPI record last updated?

The NPPES record for Derek Nishimori was last updated on June 12, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since July 21, 2015PECOS Enrolled

2000 FOREST AVE STE C, SAN JOSE, CA 95128(408) 287-5900 Get Directions Write a Review

NPPES record last updated: June 12, 2021. Verified against the NPPES registry weekly; last sync: August 30, 2026.

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About Dr. Derek Yutaka Nishimori D.d.s. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. DEREK YUTAKA NISHIMORI D.D.S. (NPI 1164807012) is an individual general practice provider in San Jose, California, licensed in California (64661) and active in the NPI registry since July 2015. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1164807012

Entity TypeIndividualMale

Primary Taxonomy1223G0001X

Provider Legal NameDR. DEREK YUTAKA NISHIMORICredential: D.D.S.

Location Address2000 FOREST AVE STE CSan Jose, CA 95128-4831

Mailing Address1130 Kifer Rd Apt 504Sunnyvale, CA 94086-5392 · (805) 807-1044

Phone(408) 287-5900

Sole ProprietorNo

Enumeration DateJuly 21, 2015

Last NPPES UpdateJune 12, 2021

NPPES CertifiedJune 12, 2021

✔ NPI 1164807012 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

License✔ Licensed in CA · 64661

Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

2000 FOREST AVE STE C, San Jose, CA 95128

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Derek Yutaka Nishimori D.d.s. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95128 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$106.47 typical visit price

range $70.37 – $206.04

Typical copayment $26.61 (range $17.59 – $51.51)

Most-billed visit code 99203

Established Patient

$86.56 typical visit price

range $23.96 – $169.60

Typical copayment $21.64 (range $5.99 – $42.40)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Derek Nishimori's NPI number?

The NPI number for Derek Nishimori is 1164807012. It was assigned to this individual provider in the NPPES registry on July 21, 2015.

Where is Derek Nishimori located?

Derek Nishimori practices at 2000 Forest Ave Ste C, San Jose, CA 95128. The listed phone number is (408) 287-5900.

What is Derek Nishimori's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Is Derek Nishimori enrolled in Medicare?

Yes. Derek Nishimori is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Derek Nishimori was last updated on June 12, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.