Healthcare Provider Details

I. General information

NPI: 1871227728
Provider Name (Legal Business Name): KATHRYN LAUREN SHIMIZU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8848 CALVINE RD STE 120
SACRAMENTO CA
95828-9335
US

IV. Provider business mailing address

10182 CORNICE WAY
ELK GROVE CA
95757-5012
US

V. Phone/Fax

Practice location:
  • Phone: 916-307-6035
  • Fax:
Mailing address:
  • Phone: 925-285-4025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS108606
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: