Provider Demographics
NPI:1003267329
Name:SHIMAOKA, JUNICHI
Entity type:Individual
Prefix:
First Name:JUNICHI
Middle Name:
Last Name:SHIMAOKA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S ELLSWORTH AVE STE 802
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3926
Mailing Address - Country:US
Mailing Address - Phone:650-667-7193
Mailing Address - Fax:
Practice Address - Street 1:100 S ELLSWORTH AVE STE 802
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3926
Practice Address - Country:US
Practice Address - Phone:650-667-7193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29143103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical