Provider Demographics
NPI:1790097046
Name:SHIRAISHI, KIMBERLY KATHERINE (PA-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KATHERINE
Last Name:SHIRAISHI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3838 CALIFORNIA ST
Mailing Address - Street 2:SUITE 715
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1522
Mailing Address - Country:US
Mailing Address - Phone:415-668-8010
Mailing Address - Fax:475-752-2560
Practice Address - Street 1:3838 CALIFORNIA ST
Practice Address - Street 2:SUITE 715
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1522
Practice Address - Country:US
Practice Address - Phone:415-668-8010
Practice Address - Fax:475-752-2560
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20914363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant