MEDICARE: VALLEY PODIATRY GROUP INC

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	213E00000X	Podiatrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912919358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY PODIATRY GROUP INC

Provider Business Mailing Address
First Line	:	3031 W MARCH LANE
Second Line	:	SUITE 310
City	:	STOCKTON
State	:	CA
Zip	:	95219-6500
Country	:	US
Telephone Number	:	209-472-0800
Fax Number	:	209-472-1203

Provider Business Practice Location Address
First Line	:	3031 W MARCH LANE
Second Line	:	SUITE 310
City	:	STOCKTON
State	:	CA
Zip	:	95219-6500
Country	:	US
Telephone Number	:	209-472-0800
Fax Number	:	209-472-1203

Authorized Official
Title or Position	:	CEO
Name	:	KENNETH K SHIMOZAKI
Credential	:	DPM
Telephone Number	:	209-472-0800

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	11/19/2007

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Directions to “VALLEY PODIATRY GROUP INC ” Practice Location

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