Healthcare Provider Details

I. General information

NPI: 1558904920
Provider Name (Legal Business Name): MAI SHIMADA M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 ANDRIEUX ST
SONOMA CA
95476-6811
US

IV. Provider business mailing address

225 FELL ST APT 15
SAN FRANCISCO CA
94102-5161
US

V. Phone/Fax

Practice location:
  • Phone: 707-935-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MAI SHIMADA
Title or Position: EMERGENCY PHYSICIAN
Credential: MD
Phone: 415-606-0172