MEDICARE: MR. YASUO RICHARD SHIMOZONO RPT

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	225100000X	Physical Therapist	PT5054	CA

General Provider Information

NPI Number	:	1821232042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. YASUO RICHARD SHIMOZONO RPT

Provider Business Mailing Address
First Line	:	24 HAMMOND
Second Line	:	UNIT C
City	:	IRVINE
State	:	CA
Zip	:	92618-1680
Country	:	US
Telephone Number	:	949-770-6022
Fax Number	:	949-770-7084

Provider Business Practice Location Address
First Line	:	5810 DOWNEY AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-4517
Country	:	US
Telephone Number	:	562-398-0200
Fax Number	:	569-398-0201

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

Provider Enumeration Date	:	05/01/2009
Last Update Date	:	01/27/2010

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