Provider Demographics
NPI:1568125904
Name:KAMIMURA, MALLI
Entity Type:Individual
Prefix:MS
First Name:MALLI
Middle Name:
Last Name:KAMIMURA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4148 47TH ST
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-1502
Mailing Address - Country:US
Mailing Address - Phone:718-809-1288
Mailing Address - Fax:
Practice Address - Street 1:4148 47TH ST
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-1502
Practice Address - Country:US
Practice Address - Phone:718-809-1288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program