Healthcare Provider Details

I. General information

NPI: 1639065576
Provider Name (Legal Business Name): EKATERINA SHIMCHUK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 MARKET ST STE 569
SAN FRANCISCO CA
94102-3016
US

IV. Provider business mailing address

643 MASON ST APT 5
SAN FRANCISCO CA
94108-3840
US

V. Phone/Fax

Practice location:
  • Phone: 925-900-8523
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberL10015
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: