MEDICARE: GIA NOVELL-KIMURA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A89742	CA
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	A89742	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A89742	OTHER	CA	CALIF MEDICAL LICENSE

General Provider Information

NPI Number	:	1558317834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GIA NOVELL-KIMURA MD

Provider Business Mailing Address
First Line	:	301 S FAIR OAKS AVE STE 300
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-2562
Country	:	US
Telephone Number	:	626-795-7556
Fax Number	:	626-463-1060

Provider Business Practice Location Address
First Line	:	301 S FAIR OAKS AVE STE 300
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-2562
Country	:	US
Telephone Number	:	626-795-7556
Fax Number	:	626-463-1060

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	11/19/2014

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Directions to “ GIA NOVELL-KIMURA MD” Practice Location

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