Provider Demographics
NPI:1912986472
Name:KIMURA, DANIEL K (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:K
Last Name:KIMURA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11600 WILSHIRE BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1733
Mailing Address - Country:US
Mailing Address - Phone:310-475-7602
Mailing Address - Fax:310-477-0866
Practice Address - Street 1:11600 WILSHIRE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1733
Practice Address - Country:US
Practice Address - Phone:310-475-7602
Practice Address - Fax:310-477-0866
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11476T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0114760Medicaid
CAU83013Medicare UPIN
CAWOP11476AMedicare PIN