Provider Demographics
NPI:1932145133
Name:SHITABATA, PAUL K (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:K
Last Name:SHITABATA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3870 DEL AMO BLVD
Mailing Address - Street 2:UNIT 507
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-2165
Mailing Address - Country:US
Mailing Address - Phone:310-561-8503
Mailing Address - Fax:310-347-4381
Practice Address - Street 1:3870 DEL AMO BLVD
Practice Address - Street 2:UNIT 507
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-2165
Practice Address - Country:US
Practice Address - Phone:310-561-8503
Practice Address - Fax:310-347-4381
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG67270207ZD0900X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G672700Medicaid
CA00G672700Medicaid
CAG02716Medicare UPIN