Provider Demographics
NPI:1790019016
Name:KIMURA, BRUCE JAMES
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:JAMES
Last Name:KIMURA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 W GREENWAY RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-4309
Mailing Address - Country:US
Mailing Address - Phone:602-375-3948
Mailing Address - Fax:602-789-9446
Practice Address - Street 1:1924 W GREENWAY RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-4309
Practice Address - Country:US
Practice Address - Phone:602-375-3948
Practice Address - Fax:602-789-9446
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZROC174046171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications