Healthcare Provider Details

I. General information

NPI: 1336084573
Provider Name (Legal Business Name): KIM SHIMAZAKI AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2175 THE ALAMEDA
SAN JOSE CA
95126-1151
US

IV. Provider business mailing address

1301 HARKER AVE
PALO ALTO CA
94301-3424
US

V. Phone/Fax

Practice location:
  • Phone: 650-394-7996
  • Fax:
Mailing address:
  • Phone: 650-288-9681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT159645
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: