MEDICARE: DR. SIMON ZIMNOWODZKI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	G88053	CA
2	2084N0400X	Neurology Physician	036066313	IL
3	2084N0600X	Clinical Neurophysiology Physician	G88053	CA
4	2084N0008X	Neuromuscular Medicine (Psychiatry & Neurology) Physician	G88053	CA

General Provider Information

NPI Number	:	1437182292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIMON ZIMNOWODZKI M.D.

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 UCLA MEDICAL PLZ STE B200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-8346
Country	:	US
Telephone Number	:	310-794-1195
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	03/07/2023

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