Healthcare Provider Details

I. General information

NPI: 1558317834
Provider Name (Legal Business Name): GIA NOVELL-KIMURA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 11/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S FAIR OAKS AVE STE 300
PASADENA CA
91105-2562
US

IV. Provider business mailing address

301 S FAIR OAKS AVE STE 300
PASADENA CA
91105-2562
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-7556
  • Fax: 626-463-1060
Mailing address:
  • Phone: 626-795-7556
  • Fax: 626-463-1060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA89742
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA89742
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: