Provider Demographics
NPI:1255439311
Name:IRIMAJIRI, SHIGEO (MD)
Entity type:Individual
Prefix:DR
First Name:SHIGEO
Middle Name:
Last Name:IRIMAJIRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23517 MAIN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-5234
Mailing Address - Country:US
Mailing Address - Phone:310-844-7171
Mailing Address - Fax:
Practice Address - Street 1:23517 MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-5234
Practice Address - Country:US
Practice Address - Phone:310-844-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94665208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice