MEDICARE: KIMI SHIMADA

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1821553124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMI SHIMADA

Provider Business Mailing Address
First Line	:	7232 BOURBON LN
Second Line	:
City	:	LA PALMA
State	:	CA
Zip	:	90623-1115
Country	:	US
Telephone Number	:	714-757-2508
Fax Number	:

Provider Business Practice Location Address
First Line	:	1230 ROSECRANS AVE STE 250
Second Line	:
City	:	MANHATTAN BCH
State	:	CA
Zip	:	90266-2496
Country	:	US
Telephone Number	:	310-406-1500
Fax Number	:

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

Provider Enumeration Date	:	01/31/2019
Last Update Date	:	01/31/2019

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Directions to “ KIMI SHIMADA ” Practice Location

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