Provider Demographics
NPI:1386663615
Name:SHIMOYAMA, STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:SHIMOYAMA
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 1:4644 LINCOLN BLVD
Mailing Address - Street 2:SUITE 414
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6313
Mailing Address - Country:US
Mailing Address - Phone:310-821-5723
Mailing Address - Fax:310-821-5828
Practice Address - Street 1:4644 LINCOLN BLVD
Practice Address - Street 2:SUITE 414
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6313
Practice Address - Country:US
Practice Address - Phone:310-821-5723
Practice Address - Fax:310-821-5828
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47794207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA954233875Medicaid
CA954233875OtherEMPLOYER TAX ID
CAG47794Medicare ID - Type UnspecifiedSTATE LICENSE
CA954233875Medicaid