Provider Demographics
NPI:1821553124
Name:SHIMADA, KIMI
Entity Type:Individual
Prefix:
First Name:KIMI
Middle Name:
Last Name:SHIMADA
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 1:7232 BOURBON LN
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1115
Mailing Address - Country:US
Mailing Address - Phone:714-757-2508
Mailing Address - Fax:
Practice Address - Street 1:1230 ROSECRANS AVE STE 250
Practice Address - Street 2:
Practice Address - City:MANHATTAN BCH
Practice Address - State:CA
Practice Address - Zip Code:90266-2496
Practice Address - Country:US
Practice Address - Phone:310-406-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst