Provider Demographics
NPI:1083766166
Name:SHIBUYA, KAREN FUMIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:FUMIE
Last Name:SHIBUYA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2452 FENTON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4552
Mailing Address - Country:US
Mailing Address - Phone:619-946-4133
Mailing Address - Fax:619-781-8547
Practice Address - Street 1:2452 FENTON ST STE 300
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4552
Practice Address - Country:US
Practice Address - Phone:619-946-4133
Practice Address - Fax:619-781-8547
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA419991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice