Provider Demographics
NPI:1689875304
Name:SHIMOKAWA, MALIA ANNE LAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MALIA
Middle Name:ANNE LAM
Last Name:SHIMOKAWA
Suffix:
Gender:F
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:UNIT 31403 BOX 13
Mailing Address - Street 2:USAHC-VICENZA, DEPARTMENT OF PEDIATRICS
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09630-1403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UNIT 31403 BOX 13
Practice Address - Street 2:USAHC-VICENZA, DEPARTMENT OF PEDIATRICS
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09630-1403
Practice Address - Country:US
Practice Address - Phone:314-636-9020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-14380208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN