Provider Demographics
NPI:1093809790
Name:KIMURA, BRUCE JOHN (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:JOHN
Last Name:KIMURA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 WASHINGTON ST
Mailing Address - Street 2:SUITE 512
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2231
Mailing Address - Country:US
Mailing Address - Phone:619-297-0014
Mailing Address - Fax:619-297-1014
Practice Address - Street 1:501 WASHINGTON ST
Practice Address - Street 2:SUITE 512
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2231
Practice Address - Country:US
Practice Address - Phone:619-297-0014
Practice Address - Fax:619-297-1014
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69109207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G691090Medicaid
CA00G391091Medicaid
CARHC137936OtherXRAY FLUROSCOPY
CA00G691090Medicaid
CAG69109Medicare ID - Type Unspecified