Healthcare Provider Details

I. General information

NPI: 1902564396
Provider Name (Legal Business Name): SHIHO KOJIMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHIHO KOJIMA AANP

II. Dates (important events)

Enumeration Date: 12/02/2021
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23181 VERDUGO DR STE 103A
LAGUNA HILLS CA
92653-1313
US

IV. Provider business mailing address

4657 ENSENADA DR
WOODLAND HILLS CA
91364-5413
US

V. Phone/Fax

Practice location:
  • Phone: 949-366-1053
  • Fax:
Mailing address:
  • Phone: 424-230-4729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95019259
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: