Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E3847 | CA |
Y | 222Z00000X | Podiatrist | E3847 | CA |
NPI | 1053429027 |
---|---|
Provider Name | Kenneth K Shimozaki |
First Address | Stockton, CA 95219-6500 |
Second Address | Stockton, CA 95219-6500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 19/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E3847 | STATE LICENSE # (01) | CA |
GRE001670 | (05) | CA |
U36947 | (02) | CA |