Healthcare Provider Details

I. General information

NPI: 1275562985
Provider Name (Legal Business Name): SHAWN ISAO KIMURA DC,L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: SHAWN KIMURA D.C., L.AC., B.S.

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8121 W. 3RD ST.
LOS ANGELES CA
90048-4308
US

IV. Provider business mailing address

8121 W. 3RD ST.
LOS ANGELES CA
90048-4308
US

V. Phone/Fax

Practice location:
  • Phone: 323-852-1023
  • Fax: 323-651-1533
Mailing address:
  • Phone: 323-852-1023
  • Fax: 323-651-1533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC16449
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC16449
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC6670
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: