Provider Demographics
NPI:1124567383
Name:SHIMIZU, DEMI PHAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEMI
Middle Name:PHAM
Last Name:SHIMIZU
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 1:1763 FOXWORTHY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-2406
Mailing Address - Country:US
Mailing Address - Phone:408-887-2499
Mailing Address - Fax:
Practice Address - Street 1:2050 JUDAH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-1531
Practice Address - Country:US
Practice Address - Phone:415-681-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1036921223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry