MEDICARE: DR. KRISTIAN SHINYU GIMA D.O.

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	208D00000X	General Practice Physician	20A13550	CA

General Provider Information

NPI Number	:	1629334032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTIAN SHINYU GIMA D.O.

Provider Business Mailing Address
First Line	:	1438 3RD ST UNIT B
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94607-1806
Country	:	US
Telephone Number	:	415-606-1752
Fax Number	:

Provider Business Practice Location Address
First Line	:	1438 3RD ST UNIT B
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94607-1806
Country	:	US
Telephone Number	:	415-606-1752
Fax Number	:

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

Provider Enumeration Date	:	04/10/2012
Last Update Date	:	05/22/2015

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