Provider Demographics
NPI:1205004280
Name:PAUL K. SHITABATA, M.D., INC
Entity Type:Organization
Organization Name:PAUL K. SHITABATA, M.D., INC
Other - Org Name:DERMATOPATHOLOGY INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:SHITABATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-963-7284
Mailing Address - Street 1:3870 DEL AMO BLVD
Mailing Address - Street 2:UNIT 507
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-2165
Mailing Address - Country:US
Mailing Address - Phone:310-963-7284
Mailing Address - Fax:310-347-4381
Practice Address - Street 1:3870 DEL AMO BLVD
Practice Address - Street 2:UNIT 507
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-7701
Practice Address - Country:US
Practice Address - Phone:310-963-7284
Practice Address - Fax:310-347-4381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG02716Medicare UPIN