Provider Demographics
NPI:1558317834
Name:NOVELL-KIMURA, GIA (MD)
Entity type:Individual
Prefix:
First Name:GIA
Middle Name:
Last Name:NOVELL-KIMURA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S FAIR OAKS AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2562
Mailing Address - Country:US
Mailing Address - Phone:626-795-7556
Mailing Address - Fax:626-463-1060
Practice Address - Street 1:301 S FAIR OAKS AVE STE 300
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2562
Practice Address - Country:US
Practice Address - Phone:626-795-7556
Practice Address - Fax:626-463-1060
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89742207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA89742OtherCALIF MEDICAL LICENSE
CAI52708Medicare UPIN